Provider Demographics
NPI:1144342379
Name:ROTHMAN, GARY JAY (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:JAY
Last Name:ROTHMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 MANOR ROAD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2408
Mailing Address - Country:US
Mailing Address - Phone:718-447-6669
Mailing Address - Fax:718-447-0499
Practice Address - Street 1:306 MANOR ROAD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-2408
Practice Address - Country:US
Practice Address - Phone:718-447-6669
Practice Address - Fax:718-447-0499
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0339291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice