Provider Demographics
NPI:1124017512
Name:ROTHBERGER, MELVIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:J
Last Name:ROTHBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMD1244761207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00271027Medicaid
NY00271027Medicaid
NY310341Medicare PIN