Provider Demographics
NPI:1477016145
Name:ROTH, NATALIA (NP)
Entity Type:Individual
Prefix:MRS
First Name:NATALIA
Middle Name:
Last Name:ROTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 OCEAN PKWY APT 16N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8354
Mailing Address - Country:US
Mailing Address - Phone:646-460-7199
Mailing Address - Fax:
Practice Address - Street 1:VISITING NURSE SERVICE OF NEW YORK
Practice Address - Street 2:1630 EAST 15 ST
Practice Address - City:3 FL
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:212-609-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF308861-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty