Healthcare Provider Details

I. General information

NPI: 1366269870
Provider Name (Legal Business Name): DAVID ROTHAUSER LP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 5TH AVE FL 11
NEW YORK NY
10001-8017
US

IV. Provider business mailing address

415 STRATH HAVEN AVE
SWARTHMORE PA
19081-2423
US

V. Phone/Fax

Practice location:
  • Phone: 347-528-0478
  • Fax:
Mailing address:
  • Phone: 347-528-0478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number001129
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: