Provider Demographics
NPI:1932317013
Name:ROTH, FLORENCE PATRICIA (LAC)
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:PATRICIA
Last Name:ROTH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MORTON ST
Mailing Address - Street 2:3B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-4025
Mailing Address - Country:US
Mailing Address - Phone:212-243-0760
Mailing Address - Fax:
Practice Address - Street 1:422 HUDSON ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3932
Practice Address - Country:US
Practice Address - Phone:212-242-7807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000613171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist