1851554984 NPI number — JORDANA BETH ROTHSCHILD MD, MPH

Table of content: JORDANA BETH ROTHSCHILD MD, MPH (NPI 1851554984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851554984 NPI number — JORDANA BETH ROTHSCHILD MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROTHSCHILD
Provider First Name:
JORDANA
Provider Middle Name:
BETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
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:
1851554984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
STONY BROOK UNIVERSITY HOSPITAL
Provider Second Line Business Mailing Address:
PREVENTIVE MEDICINE - HSC L3 086
Provider Business Mailing Address City Name:
STONY BROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11794-7148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-444-6250
Provider Business Mailing Address Fax Number:
631-444-7525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 NESCONSET HIGHWAY BLDG 16,C
Provider Second Line Business Practice Location Address:
STONY BROOK PREVENTIVE MEDICINE SERVICES
Provider Business Practice Location Address City Name:
STONY BROOK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11790-2563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-444-8822
Provider Business Practice Location Address Fax Number:
631-444-6665
Provider Enumeration Date:
07/09/2008

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: 2083P0901X , with the licence number:  262466 , 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)





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