# DIANA ROTH MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477783462
- **Authorized official:** DIANA ROTH MD (PHYSICIAN)
- **Authorized official phone:** (718) 851-0811

## Contact information

- **Practice address:** 5211 15TH AVE, BROOKLYN, NY 11219-3997
- **Practice address phone:** (718) 851-0811
- **Practice address fax:** (718) 851-0558
- **Mailing address:** 5211 15TH AVE, BROOKLYN, NY 11219-3997
- **Mailing address phone:** (718) 851-0811
- **Mailing address fax:** (718) 851-0558

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 225761 | NY | Yes |

## Other

- **Enumeration date:** 07/23/2009
- **Last updated:** 07/23/2009