Provider Demographics
NPI:1447434394
Name:ROSENFELDER, RUTHELLEN (PHD)
Entity type:Individual
Prefix:DR
First Name:RUTHELLEN
Middle Name:
Last Name:ROSENFELDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:RUTHELLEN
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:23 PARK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024
Mailing Address - Country:US
Mailing Address - Phone:516-487-4541
Mailing Address - Fax:
Practice Address - Street 1:23 PARK CIRCLE
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11024
Practice Address - Country:US
Practice Address - Phone:516-487-4541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004826103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV21121Medicare PIN