Provider Demographics
NPI:1710985379
Name:ROTH, AARON EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:EDWARD
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 SEACORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-3217
Mailing Address - Country:US
Mailing Address - Phone:914-949-3988
Mailing Address - Fax:
Practice Address - Street 1:90 SEACORD RD
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-3217
Practice Address - Country:US
Practice Address - Phone:914-949-3988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2021-09-20
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
NY191879-1207QA0505X, 208600000X
NJ25MA09806500207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA09806500OtherNJ MEDICAL LICENSE
NJ25MA09806500OtherNJ MEDICAL LICENSE