Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 288459 | NY |
NPI | 1033485867 |
---|---|
Provider Name | Randi Rothbaum |
First Address | Bronx, NY 10467 |
Second Address | Bronx, NY 10467 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2012 |
Last Update Date | 16/04/2018 |