Provider Demographics
NPI:1639314743
Name:ROSENFARB, ANDY (LAC)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:ROSENFARB
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 SOUTH AVE E
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1459
Mailing Address - Country:US
Mailing Address - Phone:908-928-0060
Mailing Address - Fax:908-928-0062
Practice Address - Street 1:332 SOUTH AVE E
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1459
Practice Address - Country:US
Practice Address - Phone:908-928-0060
Practice Address - Fax:908-928-0062
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMZ000086171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist