Provider Demographics
NPI:1932672730
Name:ROSENFELD, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ROSENFELD
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 1:22 KOWALL PL
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1427
Mailing Address - Country:US
Mailing Address - Phone:516-557-3983
Mailing Address - Fax:
Practice Address - Street 1:22 KOWALL PL
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1427
Practice Address - Country:US
Practice Address - Phone:516-557-3983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2344790174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist