Healthcare Provider Details

I. General information

NPI: 1073357521
Provider Name (Legal Business Name): DANIEL JOSEPH ROTHBART
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 CHENEY ST
NEWPORT NH
03773-1419
US

IV. Provider business mailing address

59 CHENEY ST
NEWPORT NH
03773-1419
US

V. Phone/Fax

Practice location:
  • Phone: 603-843-5437
  • Fax:
Mailing address:
  • Phone: 603-843-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: