Provider Demographics
NPI:1780240028
Name:NEIL S ROTH MD PA
Entity type:Organization
Organization Name:NEIL S ROTH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT (OWNER)
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-861-2300
Mailing Address - Street 1:210 E 64TH ST FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7471
Mailing Address - Country:US
Mailing Address - Phone:212-861-2300
Mailing Address - Fax:212-861-2300
Practice Address - Street 1:37 W CENTURY RD STE 101
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1466
Practice Address - Country:US
Practice Address - Phone:212-861-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJXX-XXX4031OtherTIN