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 5 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
1 NPI 1194968016
2 Entity Type Code 1
3 Provider Last Name Legal Name ROTH
4 Provider First Name ZACHARY
5 Provider Middle Name JOSEPH
6 Provider Name Prefix Text DR.
7 Provider Credential Text M.D.
8 Provider First Line Business Practice Location Address 713 TROY SCHENECTADY RD
9 Provider Second Line Business Practice Location Address SUITE 135
10 Provider Business Practice Location Address City Name LATHAM
11 Provider Business Practice Location Address State Name NY
12 Provider Business Practice Location Address Postal Code 121102490
13 Provider Business Practice Location Address Country Code If outside U S US
14 Provider Business Practice Location Address Telephone Number 5187827827
15 Provider Enumeration Date 4/7/2009
16 Last Update Date 4/30/2013
17 Provider Gender Code M
18 Healthcare Provider Taxonomy Code 1 390200000X
19 Provider License Number 1 62884
20 Provider License Number State Code 1 NY
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Is Sole Proprietor N

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This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.