MEDICARE: MELISSA KAY ROSENBERG

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1467837658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA KAY ROSENBERG

Provider Business Mailing Address
First Line	:	149 HAZZARD RD
Second Line	:
City	:	LIDO BEACH
State	:	NY
Zip	:	11561-4831
Country	:	US
Telephone Number	:	917-710-7962
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 HAZZARD RD
Second Line	:
City	:	LIDO BEACH
State	:	NY
Zip	:	11561-4831
Country	:	US
Telephone Number	:	917-710-7962
Fax Number	:

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

Provider Enumeration Date	:	07/29/2015
Last Update Date	:	08/19/2015

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