MEDICARE: DR. MIRANDA ROSENBERG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	02436001	NY

General Provider Information

NPI Number	:	1477294924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIRANDA ROSENBERG

Provider Business Mailing Address
First Line	:	303 5TH AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-6601
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 5TH AVE RM 403
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-6643
Country	:	US
Telephone Number	:	212-532-2322
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2022
Last Update Date	:	03/27/2023

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Directions to “ DR. MIRANDA ROSENBERG ” Practice Location

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