Healthcare Provider Details

I. General information

NPI: 1154655876
Provider Name (Legal Business Name): JAY ROOP D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

IV. Provider business mailing address

195 FORE RIVER PKWY STE 470
PORTLAND ME
04102-2787
US

V. Phone/Fax

Practice location:
  • Phone: 207-347-3164
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberDO3749
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: