Provider Demographics
NPI:1679624654
Name:IRA D ROTHFELD MD P.C.
Entity Type:Organization
Organization Name:IRA D ROTHFELD MD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:ROTHFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-861-6655
Mailing Address - Street 1:133 E 73RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3556
Mailing Address - Country:US
Mailing Address - Phone:212-861-6655
Mailing Address - Fax:212-861-3795
Practice Address - Street 1:133 E 73RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3556
Practice Address - Country:US
Practice Address - Phone:212-861-6655
Practice Address - Fax:212-861-3795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085872207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00132196Medicaid
NYB14077Medicare UPIN
NY379341Medicare ID - Type Unspecified