Provider Demographics
NPI:1598077174
Name:ROSEN, COURTNEY JEAN
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JEAN
Last Name:ROSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:BURLINGHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12722-0091
Mailing Address - Country:US
Mailing Address - Phone:845-741-3494
Mailing Address - Fax:
Practice Address - Street 1:293 ROBBINS ROAD
Practice Address - Street 2:
Practice Address - City:OTISVILLE
Practice Address - State:NY
Practice Address - Zip Code:10963
Practice Address - Country:US
Practice Address - Phone:845-741-3494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007510-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist