MEDICARE: MS. BARBARA ROTH MSCCC/SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	006761-1	NY

General Provider Information

NPI Number	:	1649414020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BARBARA ROTH MSCCC/SLP

Provider Business Mailing Address
First Line	:	1170 OCEAN PKWY
Second Line	:	APT. 7K
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4053
Country	:	US
Telephone Number	:	718-253-4535
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 55TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4202
Country	:	US
Telephone Number	:	718-851-6100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2009
Last Update Date	:	04/29/2009

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