Provider Demographics
NPI:1114196250
Name:MELVIN JAY ROTHBERGER MD,LLC
Entity Type:Organization
Organization Name:MELVIN JAY ROTHBERGER MD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:ROTHBERGER ,MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-375-6300
Mailing Address - Street 1:575 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2046
Mailing Address - Country:US
Mailing Address - Phone:718-375-6300
Mailing Address - Fax:718-375-6331
Practice Address - Street 1:575 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2046
Practice Address - Country:US
Practice Address - Phone:718-375-6300
Practice Address - Fax:718-375-6331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124476-1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5043000001Medicare NSC
NYB12726Medicare UPIN