Healthcare Provider Details

I. General information

NPI: 1386810570
Provider Name (Legal Business Name): DR. JEFFREY ROSENBERG CHIROPRACTOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 N CENTRAL AVE
VALLEY STREAM NY
11580-2525
US

IV. Provider business mailing address

275 N CENTRAL AVE
VALLEY STREAM NY
11580-2525
US

V. Phone/Fax

Practice location:
  • Phone: 516-593-7990
  • Fax: 516-593-7991
Mailing address:
  • Phone: 516-593-7990
  • Fax: 516-593-7991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007485
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number007485
License Number StateNY

VIII. Authorized Official

Name: DR. JEFFREY ROSENBERG
Title or Position: OWNER
Credential: DC
Phone: 516-593-7990