Provider Demographics
NPI:1043029580
Name:ROSENBAUM-ALTMAN, REGINA
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:ROSENBAUM-ALTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GLEN WOOD RD
Mailing Address - Street 2:
Mailing Address - City:MILLWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10546-1005
Mailing Address - Country:US
Mailing Address - Phone:914-980-2139
Mailing Address - Fax:
Practice Address - Street 1:2 GLEN WOOD RD
Practice Address - Street 2:
Practice Address - City:MILLWOOD
Practice Address - State:NY
Practice Address - Zip Code:10546-1005
Practice Address - Country:US
Practice Address - Phone:914-980-2139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY$$$$$$$$$174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist