Provider Demographics
NPI:1225198559
Name:EPHRAIM A ROTHENBERG, DDS & STEVEN N ROTHENBERG, DDS, PC
Entity Type:Organization
Organization Name:EPHRAIM A ROTHENBERG, DDS & STEVEN N ROTHENBERG, DDS, PC
Other - Org Name:EA & SN ROTHENBERG, DDS, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROTHENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-599-3383
Mailing Address - Street 1:247 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2641
Mailing Address - Country:US
Mailing Address - Phone:516-599-3383
Mailing Address - Fax:516-599-3367
Practice Address - Street 1:247 MERRICK RD
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2641
Practice Address - Country:US
Practice Address - Phone:516-599-3383
Practice Address - Fax:516-599-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0284861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028486OtherSTATE LICENSE NUMBER