Provider Demographics
NPI:1194018655
Name:ROSENBERG, ABRAHAM W (HIS)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:W
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W 3RD ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-4776
Mailing Address - Country:US
Mailing Address - Phone:716-484-4900
Mailing Address - Fax:716-484-4902
Practice Address - Street 1:560 W 3RD ST
Practice Address - Street 2:SUITE 4
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-4776
Practice Address - Country:US
Practice Address - Phone:716-484-4900
Practice Address - Fax:716-484-4902
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000004168237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist