Physician Compare National (NPI:1124026687)

HEALTHCARE PROVIDER: S MOSHE ROTH OD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1124026687
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0749302131
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110201000053
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ROTH
	Individual professional last name
Provider First Name	S MOSHE
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3111 ROUTE 9 N
	Group Practice or individual's line 1 address
City	OLD BRIDGE
	Group Practice or individual's city
State	NJ
	Group Practice or individual's state
Zip Code	088572690
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7326792020
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y