Roth, Katherine G

Roth, Katherine G is an individual health care provider with primary practice located at 12 Medical Dr Ste D, Port Jefferson Station NY 11776-1588. She recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as her primary health care specialty. Roth, Katherine G can be contacted via phone (631) 928-1222.

Contact Information

Primary practice address
12 Medical Dr Ste D Port Jefferson Station NY 11776-1588
Phone: (631) 928-1222
Fax: (631) 928-8605
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 207319 New York

Profile Details

NPI number 1083695233
LBN Legal business name Roth, Katherine G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 7th, 2005
Last updated Jun 4th, 2021 - about 5 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083695233 NPPES
New York MEDICAID 01762101

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