Provider Demographics
NPI:1235596263
Name:HERMAN M DAVIDOVICZ & STUART ROTHMAN PTR
Entity Type:Organization
Organization Name:HERMAN M DAVIDOVICZ & STUART ROTHMAN PTR
Other - Org Name:LI NEURI PSYCHOLOGICAL CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:516-487-4466
Mailing Address - Street 1:45 N STATION PLZ
Mailing Address - Street 2:ROOM 305
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5033
Mailing Address - Country:US
Mailing Address - Phone:516-487-4466
Mailing Address - Fax:516-487-4485
Practice Address - Street 1:45 N STATION PLZ
Practice Address - Street 2:ROOM 305
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5033
Practice Address - Country:US
Practice Address - Phone:516-487-4466
Practice Address - Fax:516-487-4485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty