DR. ZACHARY JOSEPH ROTH, M.D. - NPI NUMBER 1194968016

Summary

Provider Name: DR. ZACHARY JOSEPH ROTH, M.D.

NPI Number: 1194968016

Clasification: Student in an Organized Health Care Education/Training Program (390200000X)

Organization: ROBERT E BRASS MD PLLC

Address:
713 TROY SCHENECTADY RD
SUITE 135
LATHAM, NY
ZIP 12110

Phone Number: (518) 782-7827



Detailed Information

DR. Zachary Joseph Roth, M.D. is a student in an organized health care education/training program in Latham, NY with 6 years of experience. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. The assigned NPI number for this provider is 1194968016 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: TEMPLE UNIVERSITY SCHOOL OF MEDICINE
Graduation Year: 2009

The provider's business address is:

713 TROY SCHENECTADY RD
SUITE 135
LATHAM, NY
ZIP 12110-490
Phone: (518) 782-7827

The enumeration date for this NPI number is 4/7/2009 and was last updated on 4/30/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 390200000X Student in an Organized Health Care Education/Training Program 62884 NY Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1194968016 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 1 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Provider Last Name Legal Name ROTH The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name ZACHARY The first name of the provider, if the provider is an individual.
5 Provider Middle Name JOSEPH The middle name of the provider, if the provider is an individual.
6 Provider Name Prefix Text DR. The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
7 Provider Credential Text M.D. The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
8 Provider First Line Business Practice Location Address 713 TROY SCHENECTADY RD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Second Line Business Practice Location Address SUITE 135 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
10 Provider Business Practice Location Address City Name LATHAM The city name in the location address of the provider being identified.
11 Provider Business Practice Location Address State Name NY The State code in the location of the provider being identified.
12 Provider Business Practice Location Address Postal Code 121102490 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
13 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
14 Provider Business Practice Location Address Telephone Number 5187827827 The telephone number associated with the location address of the provider being identified.
15 Provider Enumeration Date 4/7/2009 The date the provider was assigned a unique identifier (assigned an NPI).
16 Last Update Date 4/30/2013 The date that a record was last updated or changed.
17 Provider Gender Code M The code designating the provider’s gender if the provider is a person.
18 Healthcare Provider Taxonomy Code 1 390200000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Provider License Number 1 62884 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
20 Provider License Number State Code 1 NY The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Is Sole Proprietor N Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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