Provider Demographics
NPI:1841475720
Name:ROTHAFEL, DAVID STEWUART
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:STEWUART
Last Name:ROTHAFEL
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 1:2A DEVON ST
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3212
Mailing Address - Country:US
Mailing Address - Phone:516-593-7984
Mailing Address - Fax:
Practice Address - Street 1:5125 MERRIK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PK
Practice Address - State:NE
Practice Address - Zip Code:11762
Practice Address - Country:US
Practice Address - Phone:516-798-7677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist