Provider Demographics
NPI:1366677544
Name:ROTHSTEIN, JEFFREY T (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:T
Last Name:ROTHSTEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7952 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1204
Mailing Address - Country:US
Mailing Address - Phone:516-496-8101
Mailing Address - Fax:516-496-8180
Practice Address - Street 1:7952 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1204
Practice Address - Country:US
Practice Address - Phone:516-496-8101
Practice Address - Fax:516-496-8180
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0431081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice