1639201775 NPI number — DR. GITTA ROTT O.D.

Table of content: DR. GITTA ROTT O.D. (NPI 1639201775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639201775 NPI number — DR. GITTA ROTT O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROTT
Provider First Name:
GITTA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
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:
1639201775
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 E 66TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10021-6148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-794-4555
Provider Business Mailing Address Fax Number:
212-472-8041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 E 66TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10021-6148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-794-4555
Provider Business Practice Location Address Fax Number:
212-472-8041
Provider Enumeration Date:
03/12/2007

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: 152WC0802X , with the licence number:  TUV005187-1 , 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: 4348495 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1947781 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9092452 . This is a "PHCS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 80314 . This is a "UNICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: C47811 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1032297 . This is a "UNITEDHEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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