MEDICARE: MRS. ANNE ROSENBERG RD CDN

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	133V00000X	Registered Dietitian	811742	NY

General Provider Information

NPI Number	:	1407046782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNE ROSENBERG RD CDN

Provider Business Mailing Address
First Line	:	1468 EAST 14TH STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6610
Country	:	US
Telephone Number	:	917-696-7985
Fax Number	:	718-339-0578

Provider Business Practice Location Address
First Line	:	1468 EAST 14TH STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6610
Country	:	US
Telephone Number	:	917-696-7985
Fax Number	:	718-339-0578

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

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	08/01/2007

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