Provider Demographics
NPI:1689869786
Name:ROBERT ROTHSTEIN, MD PC
Entity Type:Organization
Organization Name:ROBERT ROTHSTEIN, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-261-2727
Mailing Address - Street 1:10814 72ND AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5301
Mailing Address - Country:US
Mailing Address - Phone:718-261-2727
Mailing Address - Fax:718-261-5302
Practice Address - Street 1:10814 72ND AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5301
Practice Address - Country:US
Practice Address - Phone:718-261-2727
Practice Address - Fax:718-261-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205751207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01997828Medicaid
NY91T191Medicare PIN
NYG59518Medicare UPIN