Provider Demographics
NPI:1285674358
Name:ROTHFARB, STEVEN H (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:H
Last Name:ROTHFARB
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 1:714 MALLARD ST
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-2313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1450 E CHESTNUT AVE
Practice Address - Street 2:BUILDING 4, SUITE A
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-8467
Practice Address - Country:US
Practice Address - Phone:856-794-8664
Practice Address - Fax:856-794-2671
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA353132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0421907000OtherAMERIHEALTH
NJ0566403Medicaid
NJ1172523OtherHORIZON NJ HEALTH
NJ300127245OtherRAILROAD MEDICARE
NJ0566403Medicaid
NJC58602Medicare UPIN