Provider Demographics
NPI:1114359312
Name:ARIELLA ROTH
Entity Type:Organization
Organization Name:ARIELLA ROTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SI
Authorized Official - Prefix:
Authorized Official - First Name:ARIELLA
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-589-6209
Mailing Address - Street 1:2141 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3607
Mailing Address - Country:US
Mailing Address - Phone:917-589-6209
Mailing Address - Fax:
Practice Address - Street 1:2141 E 21ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3607
Practice Address - Country:US
Practice Address - Phone:917-589-6209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency