Provider Demographics
NPI:1245511542
Name:ROSENBERG, ADELLA (SLP)
Entity type:Individual
Prefix:
First Name:ADELLA
Middle Name:
Last Name:ROSENBERG
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 1:1653 53RD ST
Mailing Address - Street 2:MAIN ENTRANCE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1421
Mailing Address - Country:US
Mailing Address - Phone:347-622-0349
Mailing Address - Fax:
Practice Address - Street 1:1653 53RD ST
Practice Address - Street 2:MAIN ENTRANCE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1421
Practice Address - Country:US
Practice Address - Phone:347-622-0349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNW46510XMedicaid