Provider Demographics
NPI:1033571781
Name:GABRIELLE ROTHMAN, SLP, PC
Entity Type:Organization
Organization Name:GABRIELLE ROTHMAN, SLP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-597-5709
Mailing Address - Street 1:715 162ND ST
Mailing Address - Street 2:APT 5A
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2043
Mailing Address - Country:US
Mailing Address - Phone:917-597-5708
Mailing Address - Fax:
Practice Address - Street 1:715 162ND ST
Practice Address - Street 2:APT 5A
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-2043
Practice Address - Country:US
Practice Address - Phone:917-597-5708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013960-1305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization