Provider Demographics
NPI:1245284439
Name:ROTHENBERG, MEREDITH (AUD)
Entity type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:
Last Name:ROTHENBERG
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 BRANT AVE
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1534
Mailing Address - Country:US
Mailing Address - Phone:732-574-3550
Mailing Address - Fax:732-574-2632
Practice Address - Street 1:48 BRANT AVE
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1534
Practice Address - Country:US
Practice Address - Phone:732-574-3550
Practice Address - Fax:732-574-2632
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00004200237600000X
NJ25MG00051200237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3302407Medicaid
NJ3302407Medicaid
NJHE860716Medicare ID - Type Unspecified