Provider Demographics
NPI:1730114620
Name:ROTHBERGER, ALAN HERBERT (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:HERBERT
Last Name:ROTHBERGER
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 1:825 OCEAN PKWY
Mailing Address - Street 2:APT BB
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2755
Mailing Address - Country:US
Mailing Address - Phone:718-421-0047
Mailing Address - Fax:718-859-3017
Practice Address - Street 1:825 OCEAN PKWY
Practice Address - Street 2:APT BB
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2755
Practice Address - Country:US
Practice Address - Phone:718-421-0047
Practice Address - Fax:718-859-3017
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY46A241OtherEMPIRE BC
P00153171OtherRR MEDICARE
NY00582485Medicaid
46A241Medicare PIN
NY00582485Medicaid