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General NPI Number Information
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NPI Number | 1205745635
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Entity Type | Individual
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Provider Name | MATTHEW JACOB ROTH LAC
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Gender | Male
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Dates
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Enumeration Date | 09/02/2026
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Last Update Date | 09/02/2026
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Provider Practice Location Address
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Address Line | 2510 WESTCHESTER AVE STE 110
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City | BRONX
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State | NY
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Zip | 10461-3585
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Country | US
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Telephone | 929-303-1666
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Fax |
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Provider Business Mailing Address
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Address Line | 133 LINCOLN AVE APT 3
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City | BRONX
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State | NY
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Zip | 10454-4432
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Country | US
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Telephone | 929-303-1666
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 007969
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License Number State | NY
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