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General NPI Number Information
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NPI Number | 1073178729
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Entity Type | Individual
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Provider Name | COURTNEY ANN ROTH
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Gender | Female
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 05/08/2019
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Provider Practice Location Address
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Address Line | 73A E OLD COUNTRY RD
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City | HICKSVILLE
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State | NY
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Zip | 11801-4200
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Country | US
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Telephone | 516-520-8736
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Fax | 516-433-4840
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Provider Business Mailing Address
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Address Line | 8 ELDERWOOD LN
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City | MELVILLE
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State | NY
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Zip | 11747-1512
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Country | US
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Telephone | 631-935-5388
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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