Active NPI
Judith G Roth
- Nutrition Chiropractor
- Lido Beach, NY
National Provider Identifier
1538145644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutrition Chiropractor
- License
- XOO4297
- Practice address
- 164 Blackheath Rd
Lido Beach, NY 11561-4840 - Phone
- (516) 431-2636
- Fax
- (516) 432-5841
- NPI assigned
- Dec 20, 2005
- Last updated
- May 20, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Nutrition Chiropractor | 111NN1001X | XOO4297 | NY | Primary |
Addresses
Primary practice location
164 Blackheath Rd
Lido Beach, NY 11561-4840
Mailing address
164 Blackheath Rd
Lido Beach, NY 11561-4840
Phone (516) 431-2636
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| XOO4297 | NY | MD | Nutrition Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211241600000",
"number": "1538145644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "164 BLACKHEATH RD",
"city": "LIDO BEACH",
"state": "NY",
"postal_code": "115614840",
"telephone_number": "516-431-2636",
"fax_number": "516-432-5841"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "164 BLACKHEATH RD",
"city": "LIDO BEACH",
"state": "NY",
"postal_code": "115614840",
"telephone_number": "516-431-2636",
"fax_number": "516-432-5841"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTH",
"first_name": "JUDITH",
"middle_name": "G",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-12-20",
"last_updated": "2008-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "111NN1001X",
"taxonomy_group": "",
"desc": "Chiropractor, Nutrition",
"state": "NY",
"license": "XOO4297",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lido Beach, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.