Roth, Robert G
Roth, Robert G is an sole proprietor health care provider with primary practice located at 120 N Country Rd , Port Jefferson NY 11777-2604. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Roth, Robert G can be contacted via phone (631) 928-1222.Contact Information
Primary practice address
120 N Country Rd
Port Jefferson NY 11777-2604
Phone: (631) 928-1222
Fax: (631) 928-8605
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | 081913 | New York |
Profile Details
| NPI number | 1538140785 |
|---|---|
| LBN Legal business name | Roth, Robert G |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 7th, 2005 |
| Last updated | Mar 25th, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1538140785 | NPPES |
| New York | MEDICAID | 00390414 |
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