Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 036-095399 | IL |
Y | 207T00000X | Neurosurgeon | 35-129747 | OH |
NPI | 1013929694 |
---|---|
Provider Name | Ben Z Roitberg |
First Address | Cleveland, OH 44109-1900 |
Second Address | Cleveland, OH 44109-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 27/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H26863 | (02) | IL |