Provider Demographics
NPI:1356637961
Name:ROSENFELD, NICOLE (OT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ROSENFELD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66-36 YELLOWSTONE BLVD
Mailing Address - Street 2:APT. 2C
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2550
Mailing Address - Country:US
Mailing Address - Phone:516-801-1901
Mailing Address - Fax:
Practice Address - Street 1:66-36 YELLOWSTONE BLVD
Practice Address - Street 2:APT. 2C
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2550
Practice Address - Country:US
Practice Address - Phone:516-801-1901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015472-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist