Provider Demographics
NPI:1790863140
Name:ROSENZWEIG, GLORIA M (LAC)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:M
Last Name:ROSENZWEIG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 HERITAGE HLS UNIT B
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-1709
Mailing Address - Country:US
Mailing Address - Phone:914-260-2036
Mailing Address - Fax:914-669-8030
Practice Address - Street 1:341 HERITAGE HLS UNIT B
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-1709
Practice Address - Country:US
Practice Address - Phone:914-260-2036
Practice Address - Fax:914-669-8030
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000868171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY90X601OtherBLUE CROSS ID NUMBER