Provider Demographics
NPI:1780149716
Name:ROTHSTEIN, AVROHOM J (RN)
Entity type:Individual
Prefix:MR
First Name:AVROHOM
Middle Name:J
Last Name:ROTHSTEIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:AJ
Other - Middle Name:
Other - Last Name:ROTHSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:159 FOREST PARK CIR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5145
Mailing Address - Country:US
Mailing Address - Phone:718-650-1155
Mailing Address - Fax:
Practice Address - Street 1:159 FOREST PARK CIR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5145
Practice Address - Country:US
Practice Address - Phone:718-650-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY746170163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency