Healthcare Provider Details

I. General information

NPI: 1710184536
Provider Name (Legal Business Name): TERRY MARTIN ROSENFELD MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 FLORAL VALE BLVD
YARDLEY PA
19067-5512
US

IV. Provider business mailing address

2008 WATERFORD RD
YARDLEY PA
19067-5430
US

V. Phone/Fax

Practice location:
  • Phone: 215-497-0240
  • Fax:
Mailing address:
  • Phone: 215-702-1378
  • Fax: 215-702-1379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPS000258L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: