=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295518488
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAYLEY ROTHSTEIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2023
-----------------------------------------------------
Last Update Date | 08/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 950 S OCTORARA TRL
-----------------------------------------------------
City | PARKESBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19365-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-857-6218
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 302 REYNOLDS LN
-----------------------------------------------------
City | WEST CHESTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19380-3300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-639-4230
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------