Provider Demographics
NPI:1457680373
Name:ROTHENBERG, ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:ROTHENBERG
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 1:52 PINE RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:NY
Mailing Address - Zip Code:12029
Mailing Address - Country:US
Mailing Address - Phone:518-781-4341
Mailing Address - Fax:
Practice Address - Street 1:52 PINE RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:CANAAN
Practice Address - State:NY
Practice Address - Zip Code:12029
Practice Address - Country:US
Practice Address - Phone:518-781-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1950772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05J311Medicare UPIN