Provider Demographics
NPI:1376783571
Name:ROSENBERG, JUDAH Y (C PED)
Entity Type:Individual
Prefix:
First Name:JUDAH
Middle Name:Y
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:C PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 COLES WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4878
Mailing Address - Country:US
Mailing Address - Phone:917-309-1341
Mailing Address - Fax:
Practice Address - Street 1:1352 RIVER AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5646
Practice Address - Country:US
Practice Address - Phone:917-309-1341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCPED2986174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist