Provider Demographics
NPI:1992121750
Name:NEIL S ROTH MD P C
Entity type:Organization
Organization Name:NEIL S ROTH MD P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-861-2300
Mailing Address - Street 1:210 E 64TH ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7471
Mailing Address - Country:US
Mailing Address - Phone:212-861-2300
Mailing Address - Fax:212-861-2442
Practice Address - Street 1:210 E 64TH ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7471
Practice Address - Country:US
Practice Address - Phone:212-861-2300
Practice Address - Fax:212-861-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195903-1207X00000X
NY241830207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty