MEDICARE: ALLISON MARLA ROTHMAN PH.D.

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	103T00000X	Psychologist	018831-1	NY

General Provider Information

NPI Number	:	1285932574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON MARLA ROTHMAN PH.D.

Provider Business Mailing Address
First Line	:	100 W 12TH ST APT 4R
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10011-8242
Country	:	US
Telephone Number	:	917-628-8516
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 E 12TH ST RM 503
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-4560
Country	:	US
Telephone Number	:	917-628-8516
Fax Number	:

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

Provider Enumeration Date	:	03/10/2011
Last Update Date	:	03/10/2011

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