Provider Demographics
NPI:1376733410
Name:ROTHENBERG, SCOTT MICHAEL (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:ROTHENBERG
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E 36TH ST
Mailing Address - Street 2:APARTMENT 20C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3670
Mailing Address - Country:US
Mailing Address - Phone:347-989-2010
Mailing Address - Fax:
Practice Address - Street 1:225 E 36TH ST
Practice Address - Street 2:APARTMENT 20C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3670
Practice Address - Country:US
Practice Address - Phone:347-989-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0548911223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery