Provider Demographics
NPI:1669748950
Name:ROSENFELD, MINDEL (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:MINDEL
Middle Name:
Last Name:ROSENFELD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:693 CROWN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5303
Mailing Address - Country:US
Mailing Address - Phone:347-569-7951
Mailing Address - Fax:
Practice Address - Street 1:693 CROWN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5303
Practice Address - Country:US
Practice Address - Phone:347-569-7951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017180172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker