Provider Demographics
NPI:1083800692
Name:ROTMAN, SEM (DDS)
Entity Type:Individual
Prefix:MR
First Name:SEM
Middle Name:
Last Name:ROTMAN
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 1:6838 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VLG
Mailing Address - State:NY
Mailing Address - Zip Code:11379
Mailing Address - Country:US
Mailing Address - Phone:718-894-4474
Mailing Address - Fax:718-894-4474
Practice Address - Street 1:6838 FOREST AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VLG
Practice Address - State:NY
Practice Address - Zip Code:11379
Practice Address - Country:US
Practice Address - Phone:718-894-4474
Practice Address - Fax:718-894-4474
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034149122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00428217Medicaid