Provider Demographics
NPI:1669538351
Name:ROSENBERG, CHAYA (RD, RN, CNL)
Entity type:Individual
Prefix:
First Name:CHAYA
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:RD, RN, CNL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 LUPINE WAY
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078
Mailing Address - Country:US
Mailing Address - Phone:347-612-9105
Mailing Address - Fax:
Practice Address - Street 1:400 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-2515
Practice Address - Country:US
Practice Address - Phone:973-912-9817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY821980133V00000X
NJ0026NR14644800163WN0002X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04854LMedicare UPIN