Provider Demographics
NPI:1477588838
Name:ROTHMAN, LISA
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:ROTHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 E 233RD ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2802
Mailing Address - Country:US
Mailing Address - Phone:718-798-9411
Mailing Address - Fax:718-798-9409
Practice Address - Street 1:658 E 233RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2802
Practice Address - Country:US
Practice Address - Phone:718-798-9411
Practice Address - Fax:718-798-9409
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005671213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPB6701Medicare ID - Type Unspecified