MEDICARE: ELANA ROSOF PH.D.

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	103TH0004X	Health Psychologist	68016455	NY

General Provider Information

NPI Number	:	1538344791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELANA ROSOF PH.D.

Provider Business Mailing Address
First Line	:	31 JACOBSON AVE
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-4323
Country	:	US
Telephone Number	:	917-519-6513
Fax Number	:

Provider Business Practice Location Address
First Line	:	229 MAIN ST
Second Line	:	SUITE 200
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-6933
Country	:	US
Telephone Number	:	917-519-6513
Fax Number	:

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

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	01/07/2008

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