Provider Demographics
NPI:1326056227
Name:ROTHENBERG, NANCY A (DO)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:ROTHENBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 OLD TAPPAN RD
Mailing Address - Street 2:OLD TAPPAN PEDIATRICS
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675
Mailing Address - Country:US
Mailing Address - Phone:201-666-1000
Mailing Address - Fax:201-666-7610
Practice Address - Street 1:215 OLD TAPPAN RD
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-666-1000
Practice Address - Fax:201-666-7610
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB05630800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
13347OtherUSHC
BP197OtherOXFORD
221941517009OtherPRUDENTIAL
8849471008OtherCIGNA
23785OtherMASTERCARE
040056308NJ01OtherANTHEM HEALTH
80672OtherAMERIGROUP
1979064OtherUNITED HLTHCR
998604OtherHEALTHNET REFERRAL
4233290OtherAETNA
58H201OtherEMPIRE HLTHCR
F01397OtherHEALTHNET
4241232OtherAETNA
NJ7909705Medicaid
BP197OtherOXFORD
998604OtherHEALTHNET REFERRAL