MEDICARE: DR. ALAN ROBERT ROTH D.O.

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	207Q00000X	Family Medicine Physician	171010	NY
2	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	171010	NY

General Provider Information

NPI Number	:	1801904313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN ROBERT ROTH D.O.

Provider Business Mailing Address
First Line	:	8900 VAN WYCK EXPY
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-2897
Country	:	US
Telephone Number	:	718-206-6914
Fax Number	:	718-206-8716

Provider Business Practice Location Address
First Line	:	8900 VAN WYCK EXPY
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-2897
Country	:	US
Telephone Number	:	718-206-6914
Fax Number	:	718-206-8716

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	08/01/2024

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