Provider Demographics
NPI:1679578785
Name:ROTH, STEVEN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DAVID
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:24 PARK RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-2142
Mailing Address - Country:US
Mailing Address - Phone:914-997-5720
Mailing Address - Fax:914-682-5494
Practice Address - Street 1:21 BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1504
Practice Address - Country:US
Practice Address - Phone:914-997-5720
Practice Address - Fax:914-682-5494
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2011-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1504952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC12067Medicare UPIN