Provider Demographics
NPI:1700228624
Name:ROTENBERG, KORTNEY A
Entity Type:Individual
Prefix:MISS
First Name:KORTNEY
Middle Name:A
Last Name:ROTENBERG
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 1:7 HUMMINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10524-4004
Mailing Address - Country:US
Mailing Address - Phone:845-424-4251
Mailing Address - Fax:
Practice Address - Street 1:7 HUMMINGBIRD LN
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:NY
Practice Address - Zip Code:10524-4004
Practice Address - Country:US
Practice Address - Phone:845-424-4251
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
NY1310853251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management