Provider Demographics
NPI:1235683277
Name:ROTHSTEIN, BINYAMIN
Entity type:Individual
Prefix:
First Name:BINYAMIN
Middle Name:
Last Name:ROTHSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:
Other - Last Name:ROTHSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:954 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1938
Mailing Address - Country:US
Mailing Address - Phone:484-542-6681
Mailing Address - Fax:
Practice Address - Street 1:954 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19072-1938
Practice Address - Country:US
Practice Address - Phone:484-542-6681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016724207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine