Provider Demographics
NPI:1538210570
Name:ROTHBARD, MALCOLM J (MD)
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:J
Last Name:ROTHBARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:993 PARK AVE
Mailing Address - Street 2:FL 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0921
Mailing Address - Country:US
Mailing Address - Phone:212-861-2629
Mailing Address - Fax:
Practice Address - Street 1:108 E 66TH ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-6543
Practice Address - Country:US
Practice Address - Phone:212-861-2629
Practice Address - Fax:212-744-6799
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2016-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY096611207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB19852Medicare UPIN