Basic Information
| Provider Information | |||||||||
| NPI: | 1528612892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROTHROCK | ||||||||
| FirstName: | MEGHAN | ||||||||
| MiddleName: | B | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42 GUNPOWDER DR UNIT 2166 | ||||||||
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| City: | ATHENS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120154205 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 159 JEFFERSON HTS STE C103 | ||||||||
| Address2: | |||||||||
| City: | CATSKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 124141204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189432557 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2019 | ||||||||
| LastUpdateDate: | 07/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 383040 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.