Provider Demographics
NPI:1114928116
Name:ROITBERG, DAPHNE (MD)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:
Last Name:ROITBERG
Suffix:
Gender:F
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:PO BOX 7087
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-7087
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:525 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8141
Practice Address - Country:US
Practice Address - Phone:212-888-1000
Practice Address - Fax:121-888-0188
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2116702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01983724Medicaid
NYA400109591Medicare PIN
NY01983724Medicaid
NYG90484Medicare UPIN