Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2082S0105X | Plastic Hand Surgeon | 158057 | NY |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 158057 | NY |
NPI | 1598775884 |
---|---|
Provider Name | Dr. Malcolm Zachary Roth |
First Address | Brooklyn, NY 11219-2923 |
Second Address | Brooklyn, NY 11219-2923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 02/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0015625 | GHI (01) | |
01094444 | (05) | NY |
26E721 | BCBS (01) | |
A61699 | (02) |