1003980376 NPI number — AMY BETH ROTHENBERG ND NATUROPATHIC DOCT

Table of content: AMY BETH ROTHENBERG ND NATUROPATHIC DOCT (NPI 1003980376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003980376 NPI number — AMY BETH ROTHENBERG ND NATUROPATHIC DOCT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROTHENBERG
Provider First Name:
AMY
Provider Middle Name:
BETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ND NATUROPATHIC DOCT
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:
1003980376
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:
356 MIDDLE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMHERST
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-253-5011
Provider Business Mailing Address Fax Number:
413-256-6223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 ELM STREET
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
ENFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-763-1225
Provider Business Practice Location Address Fax Number:
860-253-5041
Provider Enumeration Date:
11/20/2006

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: 175F00000X , with the licence number:  000108 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110000108CT01 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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