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Organization

GLEN COVE PHYSICAL MEDICINE, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ERIC S. ROTH MD (PC OWNER)
(516) 759-2032
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
NY
208100000X
Physical Medicine & Rehabilitation Physician
Primary
NY
225100000X
Physical Therapist
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
100140595908
UNITEDHEALTH CARE COMMUNITY PLAN
NY
01
1083705180
NPI
NY
01
1347996
UNITEDHEALTH CARE
NY
01
2373386
GHI
NY
01
4191098
CIGNA
NY
01
5239J1
EMPIRE BLUE CROSS BLUE SHIELD
NY
01
8287078
AETNA HMO
NY
01
830088P
HIP
NY
01
P4407585
OXFORD
NY
Enumeration date
10/05/2011
Last updated
04/18/2012
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