Provider Demographics
NPI:1255733408
Name:ROTTLER, ALLON
Entity type:Individual
Prefix:MR
First Name:ALLON
Middle Name:
Last Name:ROTTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 WALNUT ST
Mailing Address - Street 2:274
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1927
Mailing Address - Country:US
Mailing Address - Phone:617-630-0048
Mailing Address - Fax:
Practice Address - Street 1:72 LANGLEY RD
Practice Address - Street 2:1
Practice Address - City:NEWTON CENTER
Practice Address - State:MA
Practice Address - Zip Code:02459-1909
Practice Address - Country:US
Practice Address - Phone:617-630-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1104453174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist