Provider Demographics
NPI:1568605624
Name:ROSENBERG, ROBERT ROY (MACCCSP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ROY
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:MACCCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-4326
Mailing Address - Country:US
Mailing Address - Phone:908-902-8088
Mailing Address - Fax:908-518-9133
Practice Address - Street 1:719 GLEN AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-4326
Practice Address - Country:US
Practice Address - Phone:908-902-8088
Practice Address - Fax:908-518-9133
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-19
Last Update Date:2009-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3303-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist