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NPI Code Detail

MEDICARE: KATHERINE G ROTH MD

MEDICARE: KATHERINE G ROTH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084N0400XNeurology Physician207319NY

General Provider Information

NPI Number : 1083695233
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE G ROTH MD
Provider Business Mailing Address
First Line : 12 MEDICAL DR
Second Line : STE D
City : PORT JEFFERSON STATION
State : NY
Zip : 11776-1588
Country : US
Telephone Number : 631-928-1222
Fax Number : 631-928-8605
Provider Business Practice Location Address
First Line : 12 MEDICAL DR
Second Line : STE D
City : PORT JEFFERSON STATION
State : NY
Zip : 11776-1588
Country : US
Telephone Number : 631-928-1222
Fax Number : 631-928-8605
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 09/05/2024

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