Healthcare Provider Details

I. General information

NPI: 1043606957
Provider Name (Legal Business Name): DIANA ALDONA ROTH O'BRIEN MD, MPH, BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA ALDONA ROTHENSTEIN JULIE MD, MPH, BA

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SUMMIT AVE
MONTVALE NJ
07645-1523
US

IV. Provider business mailing address

111 MOUNTAIN AVE
NEW ROCHELLE NY
10804-4727
US

V. Phone/Fax

Practice location:
  • Phone: 201-775-7000
  • Fax:
Mailing address:
  • Phone: 917-846-1079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number304526
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: