MEDICARE: LESLEY ROTHSCHILD PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	402427	NY

General Provider Information

NPI Number	:	1801381314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLEY ROTHSCHILD PMHNP-BC

Provider Business Mailing Address
First Line	:	75 PROSPECT ST STE 207
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-3310
Country	:	US
Telephone Number	:	516-491-3175
Fax Number	:	516-597-5659

Provider Business Practice Location Address
First Line	:	75 PROSPECT ST STE 207
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-3310
Country	:	US
Telephone Number	:	516-491-3175
Fax Number	:	516-597-5659

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

Provider Enumeration Date	:	06/27/2018
Last Update Date	:	10/25/2021

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