MEDICARE: JEFFREY S ROTHBURD 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
1	207RC0000X	Cardiovascular Disease Physician	131184	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114020674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY S ROTHBURD MD

Provider Business Mailing Address
First Line	:	5 WESTWOOD CT
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-4833
Country	:	US
Telephone Number	:	516-972-0630
Fax Number	:	631-462-0591

Provider Business Practice Location Address
First Line	:	5 WESTWOOD CT
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-4833
Country	:	US
Telephone Number	:	516-972-0630
Fax Number	:	631-462-0591

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	04/28/2016

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