Provider Demographics
NPI:1124023866
Name:ROTENBERG, MELANIE WACHTEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:WACHTEL
Last Name:ROTENBERG
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 61615
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32906-1615
Mailing Address - Country:US
Mailing Address - Phone:321-327-2274
Mailing Address - Fax:321-327-2848
Practice Address - Street 1:4650 LIPSCOMB ST NE
Practice Address - Street 2:SUITE 14
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2997
Practice Address - Country:US
Practice Address - Phone:321-327-2274
Practice Address - Fax:321-327-2848
Is Sole Proprietor?:No
Enumeration Date:2005-06-18
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 65926208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25259XOtherMEDICARE
FLK1249Medicare ID - Type Unspecified
25259YMedicare ID - Type Unspecified
FL25259XOtherMEDICARE