Provider Demographics
NPI:1447355151
Name:ROSENBERG, ABBIE (RN CS)
Entity type:Individual
Prefix:
First Name:ABBIE
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:RN CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1013
Mailing Address - Country:US
Mailing Address - Phone:508-625-1660
Mailing Address - Fax:508-625-1286
Practice Address - Street 1:149 WOOD ST
Practice Address - Street 2:
Practice Address - City:HOPKINTON
Practice Address - State:MA
Practice Address - Zip Code:01748-1013
Practice Address - Country:US
Practice Address - Phone:508-625-1660
Practice Address - Fax:508-625-1286
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA173150364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANS0094Medicare ID - Type Unspecified