Healthcare Provider Details

I. General information

NPI: 1619815941
Provider Name (Legal Business Name): BENJAMIN ROTHCHILD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 MEETINGHOUSE LN
MILFORD CT
06460-6915
US

IV. Provider business mailing address

39 MEETINGHOUSE LN
MILFORD CT
06460-6915
US

V. Phone/Fax

Practice location:
  • Phone: 203-873-7629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number328441
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: