Provider Demographics
NPI:1578597308
Name:ROTHFELD, PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:ROTHFELD
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 1:385 MAIN ST SOUTH
Mailing Address - Street 2:C/O NVRA IMAGING NETWORK UNION SQUARE BLDG #1
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488
Mailing Address - Country:US
Mailing Address - Phone:203-264-7999
Mailing Address - Fax:203-264-7477
Practice Address - Street 1:385 MAIN ST SOUTH
Practice Address - Street 2:UNION SQUARE, BLDG#1
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488
Practice Address - Country:US
Practice Address - Phone:203-264-7999
Practice Address - Fax:203-264-7477
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0178782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001178789Medicaid
300003220Medicare ID - Type UnspecifiedPDI
CT001178789Medicaid
300003504Medicare ID - Type UnspecifiedHIA
C59960Medicare UPIN
300003494Medicare ID - Type UnspecifiedDIA
300002557Medicare ID - Type UnspecifiedDIS
300003489Medicare ID - Type UnspecifiedNVCI