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General NPI Number Information
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NPI Number | 1396565800
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Entity Type | Individual
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Provider Name | MIRIAM ROSENBAUM M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 1500 AVENUE OF THE STATES
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City | LAKEWOOD
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State | NJ
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Zip | 08701-4789
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Country | US
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Telephone | 732-961-7413
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Fax |
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Provider Business Mailing Address
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Address Line | 14 INDEPENDENCE CT
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City | LAKEWOOD
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State | NJ
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Zip | 08701-4158
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Country | US
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Telephone | 443-635-1366
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 41YS01289500
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License Number State | NJ
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