1801881677 NPI number — DR. LINDA ROETHEL M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801881677 NPI number — DR. LINDA ROETHEL M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ROETHEL

Provider First Name:

LINDA

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1801881677

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1 HEALTHY WAY

Provider Second Line Business Mailing Address:

ATTN: PHYSICIAN BILLING DEPT

Provider Business Mailing Address City Name:

OCEANSIDE

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

11572-1551

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

516-255-1600

Provider Business Mailing Address Fax Number:

516-255-4672

Provider First Line Business Practice Location Address:

196 MERRICK RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

OCEANSIDE

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

11572-1420

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

516-255-1616

Provider Business Practice Location Address Fax Number:

516-255-4672

Provider Enumeration Date:

09/16/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  184344 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 01425149 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 184344 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: GP160 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 000000071571 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 5903664 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 0D4451 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 5022479 . This is a "AETNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 5782299 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: AA71640 . This is a "MDNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 1000021935 . This is a "AFFINITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 2C9292 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 519648 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".