MEDICARE: MRS. CHANA ROSENBERG MS CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	41YS00581500	NJ

General Provider Information

NPI Number	:	1295272128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHANA ROSENBERG MS CCC-SLP

Provider Business Mailing Address
First Line	:	1677 HIDDEN LN
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1677 HIDDEN LN
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3912
Country	:	US
Telephone Number	:	917-363-3980
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	11/12/2021

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Directions to “ MRS. CHANA ROSENBERG MS CCC-SLP” Practice Location

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