Provider Demographics
NPI:1407046782
Name:ROSENBERG, ANNE (RD CDN)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:RD CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1468 EAST 14TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6610
Mailing Address - Country:US
Mailing Address - Phone:917-696-7985
Mailing Address - Fax:718-339-0578
Practice Address - Street 1:1468 EAST 14TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6610
Practice Address - Country:US
Practice Address - Phone:917-696-7985
Practice Address - Fax:718-339-0578
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY811742133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered