Provider Demographics
NPI:1881073146
Name:ROSENBERG, JENNIFER MARIEN
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARIEN
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 SHORE PKWY
Mailing Address - Street 2:APT 2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3918
Mailing Address - Country:US
Mailing Address - Phone:347-992-7721
Mailing Address - Fax:
Practice Address - Street 1:1009 SHORE PKWY
Practice Address - Street 2:APT 2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3918
Practice Address - Country:US
Practice Address - Phone:347-992-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1354536174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist