Provider Demographics
NPI:1922562644
Name:ROSENBERG, LILI REBEKAH (RDN)
Entity Type:Individual
Prefix:
First Name:LILI
Middle Name:REBEKAH
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 MIDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-5407
Mailing Address - Country:US
Mailing Address - Phone:202-684-1967
Mailing Address - Fax:
Practice Address - Street 1:285 MIDWOOD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5407
Practice Address - Country:US
Practice Address - Phone:202-684-1967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-27
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86089900133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty