Healthcare Provider Details

I. General information

NPI: 1528612892
Provider Name (Legal Business Name): MEGHAN B ROTHROCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 JEFFERSON HTS STE C103
CATSKILL NY
12414-1204
US

IV. Provider business mailing address

42 GUNPOWDER DR UNIT 2166
ATHENS NY
12015-4205
US

V. Phone/Fax

Practice location:
  • Phone: 518-943-2557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number383040
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: