Provider Demographics
NPI:1952665127
Name:BIRNBAUM, ROSELYN H
Entity Type:Individual
Prefix:MRS
First Name:ROSELYN
Middle Name:H
Last Name:BIRNBAUM
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 1:1182 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4816
Mailing Address - Country:US
Mailing Address - Phone:718-290-0471
Mailing Address - Fax:
Practice Address - Street 1:1182 E 15TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4816
Practice Address - Country:US
Practice Address - Phone:718-290-0471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist