Provider Demographics
NPI:1962644724
Name:TSIRULNIK, ROSA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:
Last Name:TSIRULNIK
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 DANCER LN
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8640
Mailing Address - Country:US
Mailing Address - Phone:718-644-8525
Mailing Address - Fax:718-744-2588
Practice Address - Street 1:3 DANCER LN
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8640
Practice Address - Country:US
Practice Address - Phone:718-644-8525
Practice Address - Fax:718-744-2588
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2019-11-01
Deactivation Date:2009-04-21
Deactivation Code:
Reactivation Date:2011-02-16
Provider Licenses
StateLicense IDTaxonomies
NY017416235Z00000X
NJ41YS00923300235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1962644724OtherINDIVIDUAL NPI