Provider Demographics
NPI:1962469601
Name:ROTHENBERG, STEVEN N (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:N
Last Name:ROTHENBERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2641
Mailing Address - Country:US
Mailing Address - Phone:516-599-3383
Mailing Address - Fax:516-599-3367
Practice Address - Street 1:247 MERRICK RD
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2641
Practice Address - Country:US
Practice Address - Phone:516-599-3383
Practice Address - Fax:516-599-3367
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0284861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028486OtherPROFESSIONAL LICENSE #