Provider Demographics
NPI:1679986715
Name:ROTH, LISA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:ROTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:291 BROADWAY RM 710
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-1928
Mailing Address - Country:US
Mailing Address - Phone:917-719-6156
Mailing Address - Fax:347-270-8747
Practice Address - Street 1:291 BROADWAY RM 710
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1928
Practice Address - Country:US
Practice Address - Phone:917-719-6156
Practice Address - Fax:347-270-8747
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2023-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYMD2938292084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry