Provider Demographics
NPI:1538299466
Name:ROSENBACH, NANCY (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:ROSENBACH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GRACE AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2419
Mailing Address - Country:US
Mailing Address - Phone:516-482-4570
Mailing Address - Fax:
Practice Address - Street 1:6 GRACE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2419
Practice Address - Country:US
Practice Address - Phone:516-482-4570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013299103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV83461Medicare ID - Type Unspecified