Provider Demographics
NPI:1578747499
Name:ROSENBERG, ROBIN (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2211
Mailing Address - Country:US
Mailing Address - Phone:516-935-2462
Mailing Address - Fax:516-935-2462
Practice Address - Street 1:15 BRIAR LN
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2211
Practice Address - Country:US
Practice Address - Phone:516-935-2462
Practice Address - Fax:516-935-2462
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003311235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist