Provider Demographics
NPI:1891939070
Name:ROSENTHAL, TEHILLA (RD)
Entity Type:Individual
Prefix:MS
First Name:TEHILLA
Middle Name:
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 W END AVE
Mailing Address - Street 2:APT 11F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3533
Mailing Address - Country:US
Mailing Address - Phone:718-534-0430
Mailing Address - Fax:718-859-5909
Practice Address - Street 1:910 W END AVE
Practice Address - Street 2:APT 11F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3533
Practice Address - Country:US
Practice Address - Phone:917-331-2795
Practice Address - Fax:212-961-0552
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY852588133V00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No171M00000XOther Service ProvidersCase Manager/Care Coordinator