Provider Demographics
NPI:1073621231
Name:ROTER, GIL (MD)
Entity Type:Individual
Prefix:DR
First Name:GIL
Middle Name:
Last Name:ROTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6117
Mailing Address - Country:US
Mailing Address - Phone:718-531-3703
Mailing Address - Fax:718-531-5945
Practice Address - Street 1:7001 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6117
Practice Address - Country:US
Practice Address - Phone:718-531-3703
Practice Address - Fax:718-531-5945
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01059452Medicaid
NYA61104Medicare UPIN
19E18EE1G1Medicare PIN