Provider Demographics
NPI:1699831495
Name:ROSOLINSKY, MARTIN ALAN (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:ALAN
Last Name:ROSOLINSKY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ASH DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-4301
Mailing Address - Country:US
Mailing Address - Phone:631-654-9392
Mailing Address - Fax:
Practice Address - Street 1:982 MONTAUK HIGHWAY
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705
Practice Address - Country:US
Practice Address - Phone:516-991-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRP014646-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN91571Medicare PIN