Healthcare Provider Details

I. General information

NPI: 1841457504
Provider Name (Legal Business Name): JOSEPH ROTHENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTHERN BLVD SUITE 300
GREAT NECK NY
11021-5200
US

IV. Provider business mailing address

600 NORTHERN BLVD SUITE 300
GREAT NECK NY
11021-5200
US

V. Phone/Fax

Practice location:
  • Phone: 516-627-8717
  • Fax: 516-570-4039
Mailing address:
  • Phone: 516-627-8717
  • Fax: 516-570-4039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number242938
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: