Healthcare Provider Details

I. General information

NPI: 1952935520
Provider Name (Legal Business Name): KENNETH PAUL ROTHFELD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2020
Last Update Date: 02/23/2020
Certification Date: 02/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MANOR DR
HAMPTON NJ
08827-5409
US

IV. Provider business mailing address

8 PLUMSTEAD CT
ANNANDALE NJ
08801-4003
US

V. Phone/Fax

Practice location:
  • Phone: 908-537-6815
  • Fax: 908-537-6400
Mailing address:
  • Phone: 908-507-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37PC00698400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: