Healthcare Provider Details

I. General information

NPI: 1114928116
Provider Name (Legal Business Name): DAPHNE ROITBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 PARK AVE
NEW YORK NY
10065-8141
US

IV. Provider business mailing address

PO BOX 7087
ORANGE CA
92863-7087
US

V. Phone/Fax

Practice location:
  • Phone: 212-888-1000
  • Fax: 121-888-0188
Mailing address:
  • Phone: 714-571-5000
  • Fax: 714-571-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number211670
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: