Healthcare Provider Details

I. General information

NPI: 1043918634
Provider Name (Legal Business Name): YVETTE ROSENBERG AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 04/30/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E COUNTY LINE RD STE C
LAKEWOOD NJ
08701-2082
US

IV. Provider business mailing address

921 E COUNTY LINE RD
LAKEWOOD NJ
08701-2063
US

V. Phone/Fax

Practice location:
  • Phone: 732-987-6590
  • Fax:
Mailing address:
  • Phone: 732-987-6590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00121400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: