Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 061196 | NY |
NPI | 1083187538 |
---|---|
Provider Name | Dr. Stephen Roth |
First Address | New Hyde Park, NY 11040-1402 |
Second Address | New Hyde Park, NY 11040-1402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2019 |
Last Update Date | 19/01/2021 |