Provider Demographics
NPI:1154481281
Name:ROTHENBERG, BENNETT CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:CHARLES
Last Name:ROTHENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 OLD SHORT HILLS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5604
Mailing Address - Country:US
Mailing Address - Phone:973-994-3311
Mailing Address - Fax:973-994-7005
Practice Address - Street 1:22 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5604
Practice Address - Country:US
Practice Address - Phone:973-994-3311
Practice Address - Fax:973-994-7005
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA52367174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJRO616577Medicare ID - Type Unspecified
NJE55145Medicare UPIN