Healthcare Provider Details

I. General information

NPI: 1710985379
Provider Name (Legal Business Name): AARON EDWARD ROTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date: 03/21/2006
Reactivation Date: 03/29/2006

III. Provider practice location address

90 SEACORD RD
NEW ROCHELLE NY
10804-3217
US

IV. Provider business mailing address

90 SEACORD RD
NEW ROCHELLE NY
10804-3217
US

V. Phone/Fax

Practice location:
  • Phone: 914-949-3988
  • Fax:
Mailing address:
  • Phone: 914-949-3988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number191879-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number25MA09806500
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number191879-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: