Provider Demographics
NPI:1578905568
Name:ROSEN, MALKA NECHAMA (CFY)
Entity Type:Individual
Prefix:MRS
First Name:MALKA
Middle Name:NECHAMA
Last Name:ROSEN
Suffix:
Gender:F
Credentials:CFY
Other - Prefix:
Other - First Name:MALKA
Other - Middle Name:NECHAMA
Other - Last Name:ROSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFY
Mailing Address - Street 1:1217 BEACH 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4847
Mailing Address - Country:US
Mailing Address - Phone:917-608-0739
Mailing Address - Fax:
Practice Address - Street 1:1217 BEACH 9TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4847
Practice Address - Country:US
Practice Address - Phone:917-608-0739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY757053131235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist