Healthcare Provider Details

I. General information

NPI: 1083938757
Provider Name (Legal Business Name): RIVKA R MARX ROTTENBERG MS SPECIAL ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 HADASSAH LN
LAKEWOOD NJ
08701-5559
US

IV. Provider business mailing address

132 LEONARD ST
LAKEWOOD NJ
08701-2049
US

V. Phone/Fax

Practice location:
  • Phone: 732-833-3723
  • Fax:
Mailing address:
  • Phone: 732-833-3723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: