Provider Demographics
NPI:1861498628
Name:ROTHBERG, MICHAEL STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEVEN
Last Name:ROTHBERG
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 1:2290 W COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2267
Mailing Address - Country:US
Mailing Address - Phone:732-942-4455
Mailing Address - Fax:732-942-4459
Practice Address - Street 1:2125 RT 88 EAST
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3152
Practice Address - Country:US
Practice Address - Phone:732-892-4548
Practice Address - Fax:732-892-0961
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA59550207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5611008Medicaid
NJ5611008Medicaid
NJ139446Medicare ID - Type Unspecified
NJ810301Medicare PIN