Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 200187 | NY |
NPI | 1003897992 |
---|---|
Provider Name | Susan Rothenberg |
First Address | Philadelphia, PA 19195-2428 |
Second Address | New York, NY 10003-3314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 18/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01720438 | (05) | NY |
G37767 | (02) |