1033155056 NPI number — MICHAEL L ROTHBERG MSW, LCSW

Table of content: MICHAEL L ROTHBERG MSW, LCSW (NPI 1033155056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033155056 NPI number — MICHAEL L ROTHBERG MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROTHBERG
Provider First Name:
MICHAEL
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
M

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:
1033155056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 COUNTY RD
Provider Second Line Business Mailing Address:
OFFICE #3
Provider Business Mailing Address City Name:
CRESSKILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07626-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-906-9049
Provider Business Mailing Address Fax Number:
212-645-3137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 COUNTY RD
Provider Second Line Business Practice Location Address:
OFFICE #3
Provider Business Practice Location Address City Name:
CRESSKILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07626-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-906-9049
Provider Business Practice Location Address Fax Number:
212-645-3137
Provider Enumeration Date:
06/20/2006

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: 1041C0700X , with the licence number:  44SC05222900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 305495 . This is a "MHN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 72142700 . This is a "MAGELLAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 300235859 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3175428 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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