Provider Demographics
NPI:1952046203
Name:ROTBERG, ABIGAIL (PA)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:ROTBERG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 WILLOW CT BSMT
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-6201
Mailing Address - Country:US
Mailing Address - Phone:973-699-2253
Mailing Address - Fax:
Practice Address - Street 1:1732 WILLOW CT BSMT
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-6201
Practice Address - Country:US
Practice Address - Phone:973-699-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant