Provider Demographics
NPI:1639265978
Name:ROTHBAUM, HAL (MD)
Entity Type:Individual
Prefix:DR
First Name:HAL
Middle Name:
Last Name:ROTHBAUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:233 E SHORE RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2433
Mailing Address - Country:US
Mailing Address - Phone:516-487-3466
Mailing Address - Fax:516-487-3494
Practice Address - Street 1:233 E SHORE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2433
Practice Address - Country:US
Practice Address - Phone:516-487-3466
Practice Address - Fax:516-487-3494
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY161662207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5298370OtherCIGNA
NY557D71OtherEMPIRE BLUE CROSS/BS
302004OtherUNITED HEALTHCARE
0023478OtherGROUP HEALTH INC.
4061270OtherAETNA
AP080OtherOXFORD HEALTH PLANS
302004OtherUNITED HEALTHCARE
A60561Medicare UPIN