1174529853 NPI number — ANGELA F ROTHSTEIN C.N.P.

Table of content: ANGELA F ROTHSTEIN C.N.P. (NPI 1174529853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174529853 NPI number — ANGELA F ROTHSTEIN C.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROTHSTEIN
Provider First Name:
ANGELA
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1174529853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9059 SPRINGBORO PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMISBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45342-4418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-275-8900
Provider Business Mailing Address Fax Number:
937-276-0534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 W WENGER RD
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45322-2723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-275-8900
Provider Business Practice Location Address Fax Number:
937-276-0534
Provider Enumeration Date:
06/27/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LX0001X , with the licence number:  NP-05631 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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