Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 045954 | NY |
NPI | 1174664312 |
---|---|
Provider Name | Dr. Michael Rothstein |
First Address | New City, NY 10956-5259 |
Second Address | New City, NY 10956-5259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 07/11/2008 |