Provider Demographics
NPI:1467854455
Name:ROSENBERG, ELENA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W 92ND ST APT BB
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7556
Mailing Address - Country:US
Mailing Address - Phone:212-595-1705
Mailing Address - Fax:
Practice Address - Street 1:150 W 92ND ST APT BB
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7556
Practice Address - Country:US
Practice Address - Phone:212-595-1705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024131235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist