Provider Demographics
NPI:1467659433
Name:ROTHLEIN, WILLIAM (MT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:ROTHLEIN
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BROADWAY STE 76
Mailing Address - Street 2:SUITE 254
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1674
Mailing Address - Country:US
Mailing Address - Phone:201-497-5331
Mailing Address - Fax:
Practice Address - Street 1:15 BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-2107
Practice Address - Country:US
Practice Address - Phone:201-497-5331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26BT00039600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist