Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 08279 | NY |
N | 103T00000X | Psychologist | 08279 | NY |
N | 103G00000X | Clinical Psychologist | 08279 | NY |
N | 103TC0700X | Clinical Psychologist | 08279 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 08279 | NY |
NPI | 1073606968 |
---|---|
Provider Name | Dr. Steven Roth |
First Address | New York, NY 10003 |
Second Address | New York, NY 10011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |