Active NPI
Allen M Rothenberg, MD
- Pediatrics Physician
- Howard Beach, NY
National Provider Identifier
1407921075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- NY0861771
- Practice address
- 158 49 84TH Street
Howard Beach, NY 11414 - Phone
- (718) 322-7425
- Fax
- (718) 323-5541
- NPI assigned
- Nov 21, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | NY0861771 | NY | Primary |
Addresses
Primary practice location
158 49 84TH Street
Howard Beach, NY 11414
Mailing address
158 49 84TH Street
Howard Beach, NY 11414
Phone (718) 322-7425
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160603000457 | NY | Order and Referring Only - Pediatric Medicine | 6901196906 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NY0861771 | NY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407921075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "158 49 84TH STREET",
"city": "HOWARD BEACH",
"state": "NY",
"postal_code": "11414",
"telephone_number": "718-322-7425",
"fax_number": "718-323-5541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "158 49 84TH STREET",
"city": "HOWARD BEACH",
"state": "NY",
"postal_code": "11414",
"telephone_number": "718-322-7425",
"fax_number": "718-323-5541"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTHENBERG",
"first_name": "ALLEN",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "NY0861771",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Howard Beach, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.