Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | X005405 | NY |
NPI | 1164543948 |
---|---|
Provider Name | Dr. Adria Rothfeld |
First Address | Staten Island, NY 10314-3914 |
Second Address | Colts Neck, NJ 07722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 27/06/2019 |