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1063636280
JENNIFER D ROTH
GLEN COVE, NY
NPI
1063636280
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: NY 009096)
Enumeration Date
2007-04-11
Last Update Date
2007-07-08
Business Address
-- JENNIFER D ROTH PA
104 FOREST AVE
GLEN COVE, NY 11542-2015
Phone number: 516-759-5406
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Mailing Address
-- JENNIFER D ROTH PA
4626 217TH ST
BAYSIDE, NY 11361-3530
Phone number:
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