1225198559 NPI number — EPHRAIM A ROTHENBERG, DDS & STEVEN N ROTHENBERG, DDS, PC

Table of content: (NPI 1225198559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225198559 NPI number — EPHRAIM A ROTHENBERG, DDS & STEVEN N ROTHENBERG, DDS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EPHRAIM A ROTHENBERG, DDS & STEVEN N ROTHENBERG, DDS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EA & SN ROTHENBERG, DDS, PC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225198559
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
247 MERRICK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNBROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11563-2641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-599-3383
Provider Business Mailing Address Fax Number:
516-599-3367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
247 MERRICK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNBROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11563-2641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-599-3383
Provider Business Practice Location Address Fax Number:
516-599-3367
Provider Enumeration Date:
12/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROTHENBERG
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRES.
Authorized Official Telephone Number:
516-599-3383

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  028486 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 028486 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".