MEDICARE: DR. BRUCE L ROTHSCHILD DDS

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	1223G0001X	General Practice Dentistry	041727	NY

General Provider Information

NPI Number	:	1528061199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE L ROTHSCHILD DDS

Provider Business Mailing Address
First Line	:	534 ELIZABETH AVE
Second Line	:
City	:	RIVER VALE
State	:	NJ
Zip	:	07675-5553
Country	:	US
Telephone Number	:	201-358-1258
Fax Number	:	201-358-2767

Provider Business Practice Location Address
First Line	:	75 W ROUTE 59
Second Line	:	STE 201
City	:	NANUET
State	:	NY
Zip	:	10954-2717
Country	:	US
Telephone Number	:	845-623-0305
Fax Number	:	845-623-2870

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/08/2007

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