Provider Demographics
NPI:1336359934
Name:ROSENBERG, ANDREA L (MS ED, RD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:L
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:MS ED, RD, CDN
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:FURMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS ED, RD, CDN
Mailing Address - Street 1:14 SOUNDVIEW AVE
Mailing Address - Street 2:UNIT 4
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-3327
Mailing Address - Country:US
Mailing Address - Phone:212-595-9556
Mailing Address - Fax:
Practice Address - Street 1:255 W 92ND ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7342
Practice Address - Country:US
Practice Address - Phone:212-595-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY916224133V00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Provider Identifiers
StateIdentifier IDID TypeIssuer
916224OtherREGISTERED DIETITIAN
NY005786-1OtherCERTIFIED DIETITIAN-NUTRI