Provider Demographics
NPI:1720049588
Name:ROTHKOPF, MOSHE M (MD)
Entity Type:Individual
Prefix:
First Name:MOSHE
Middle Name:M
Last Name:ROTHKOPF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5946
Mailing Address - Country:US
Mailing Address - Phone:732-363-2244
Mailing Address - Fax:732-363-1825
Practice Address - Street 1:1195 HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5946
Practice Address - Country:US
Practice Address - Phone:732-363-2244
Practice Address - Fax:732-363-1825
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04804500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3421708Medicaid
140354L4WMedicare PIN
C56425Medicare UPIN