# GLEN COVE PHYSICAL MEDICINE, PC

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

## Provider details

- **NPI number:** 1740564087
- **Authorized official:** ERIC S. ROTH MD (PC OWNER)
- **Authorized official phone:** (516) 759-2032

## Contact information

- **Practice address:** 7 VILLAGE SQ, GLEN COVE, NY 11542-2515
- **Practice address phone:** (516) 759-2032
- **Practice address fax:** (516) 759-2117
- **Mailing address:** 7 VILLAGE SQ, GLEN COVE, NY 11542-2515
- **Mailing address phone:** (516) 759-2032
- **Mailing address fax:** (516) 759-2117

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NY | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NY | Yes |
| 225100000X | Physical Therapist | — | NY | — |

## Other

- **Enumeration date:** 10/05/2011
- **Last updated:** 04/18/2012