Provider Demographics
NPI:1790661072
Name:ROTHLEDER, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ROTHLEDER
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 NEW YORK AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3435
Mailing Address - Country:US
Mailing Address - Phone:516-443-9514
Mailing Address - Fax:
Practice Address - Street 1:10 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-1833
Practice Address - Country:US
Practice Address - Phone:631-382-5205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist