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General NPI Number Information
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NPI Number | 1578861373
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Entity Type | Organization
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Legal Business Name | BENNETT C. ROTHENBERG, M.D., F.A.C.S., L.L.C.
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Dates
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Enumeration Date | 03/03/2011
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Last Update Date | 03/03/2011
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Provider Practice Location Address
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Address Line | 22 OLD SHORT HILLS RD SUITE 101
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5604
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Country | US
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Telephone | 973-994-3311
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Fax | 973-994-7005
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Provider Business Mailing Address
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Address Line | 22 OLD SHORT HILLS RD SUITE 101
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City | LIVINGSTON
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State | NJ
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Zip | 07039-5604
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Country | US
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Telephone | 973-994-3311
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Fax | 973-994-7005
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BENNETT CHARLES ROTHENBERG
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Credential | M.D.
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Telephone | 973-994-3311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 25MA05236700
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License Number State | NJ
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