Healthcare Provider Details

I. General information

NPI: 1679477954
Provider Name (Legal Business Name): MOSHE ROTH MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ROBERT PITT DR STE 101
MONSEY NY
10952-3366
US

IV. Provider business mailing address

8 ELM ST UNIT 311
SPRING VALLEY NY
10977-8326
US

V. Phone/Fax

Practice location:
  • Phone: 845-425-5252
  • Fax: 845-678-6060
Mailing address:
  • Phone: 917-600-1577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: