Healthcare Provider Details

I. General information

NPI: 1023795788
Provider Name (Legal Business Name): ADAM ROUTHER CRPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 BRIELLE AVE BLDG H
STATEN ISLAND NY
10314-6427
US

IV. Provider business mailing address

460 BRIELLE AVE BLDG H
STATEN ISLAND NY
10314-6427
US

V. Phone/Fax

Practice location:
  • Phone: 718-356-5100
  • Fax:
Mailing address:
  • Phone: 718-356-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: