Provider Demographics
NPI:1871738849
Name:ROSENBLUM, ALYSSA MICHELLE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:MICHELLE
Last Name:ROSENBLUM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1417
Mailing Address - Country:US
Mailing Address - Phone:516-509-5495
Mailing Address - Fax:
Practice Address - Street 1:29 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1417
Practice Address - Country:US
Practice Address - Phone:516-509-5495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017503-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist