Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | MD02241 | NJ |
NPI | 1033115738 |
---|---|
Provider Name | Frederick J Rothberg |
First Address | Jackson, NJ 08527-2267 |
Second Address | Toms River, NJ 08755-5043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 16/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1212830001 | MEDICARE NSC (01) | NJ |
7260601 | (05) | NJ |
U453546 | (02) | NJ |