Provider Demographics
NPI:1104170687
Name:ROSENBERG, DEBORAH LISA (RD, CDE)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LISA
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 INGHAM RD
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1704
Mailing Address - Country:US
Mailing Address - Phone:914-762-0770
Mailing Address - Fax:
Practice Address - Street 1:28 INGHAM RD
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1704
Practice Address - Country:US
Practice Address - Phone:914-762-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY726220133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered