Provider Demographics
NPI:1164784419
Name:ROTHBERGER, JOSHUA (MASTERS IN EDUCATION)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:ROTHBERGER
Suffix:
Gender:M
Credentials:MASTERS IN EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 AVENUE I
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-3050
Mailing Address - Country:US
Mailing Address - Phone:917-863-5776
Mailing Address - Fax:
Practice Address - Street 1:1620 AVENUE I APT 215
Practice Address - Street 2:215
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3048
Practice Address - Country:US
Practice Address - Phone:917-863-5776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY682219174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist