1780240028 NPI number — NEIL S ROTH MD PA

Table of content: (NPI 1780240028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780240028 NPI number — NEIL S ROTH MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEIL S ROTH MD PA
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:
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:
1780240028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 E 64TH ST FL 4
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:
10065-7471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-861-2300
Provider Business Mailing Address Fax Number:
212-861-2300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37 W CENTURY RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARAMUS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07652-1466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-861-2300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ROTH
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT (OWNER)
Authorized Official Telephone Number:
212-861-2300

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: XX-XXX4031 . This is a "TIN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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