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General NPI Number Information
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NPI Number | 1366887085
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Entity Type | Organization
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Legal Business Name | ELANA ROSOF, PHD PSYCHOLOGIST LLC
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Dates
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Enumeration Date | 05/08/2013
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 328 MAIN ST STE 202
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City | HUNTINGTON
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State | NY
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Zip | 11743-6972
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Country | US
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Telephone | 917-519-6513
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Fax |
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Provider Business Mailing Address
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Address Line | 328 MAIN ST STE 202
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City | HUNTINGTON
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State | NY
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Zip | 11743-6972
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Country | US
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Telephone | 917-519-6513
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. ELANA J. ROSOF
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Credential | PH.D.
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Telephone | 917-519-6513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 016455
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License Number State | NY
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