Provider Demographics
NPI:1497757363
Name:ROSENBERG, LORI ALYSON (DO)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ALYSON
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-431-3373
Mailing Address - Fax:732-303-0172
Practice Address - Street 1:315 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-431-3373
Practice Address - Fax:732-303-0172
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07193200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8642001Medicaid