Provider Demographics
NPI:1487622080
Name:KOSTIN-ROSENBERG, LORI IRIS (MD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:IRIS
Last Name:KOSTIN-ROSENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22544 MIDDLETOWN DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4709
Mailing Address - Country:US
Mailing Address - Phone:561-212-8747
Mailing Address - Fax:561-852-4913
Practice Address - Street 1:7305 N MILITARY TRL
Practice Address - Street 2:MHC/116
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7417
Practice Address - Country:US
Practice Address - Phone:561-422-5272
Practice Address - Fax:561-422-6992
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME719312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry