Healthcare Provider Details

I. General information

NPI: 1134514706
Provider Name (Legal Business Name): JASON ROTH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 GREENTREE RD
CHERRY HILL NJ
08003-1112
US

IV. Provider business mailing address

1907 GREENTREE RD
CHERRY HILL NJ
08003-1112
US

V. Phone/Fax

Practice location:
  • Phone: 856-424-8222
  • Fax:
Mailing address:
  • Phone: 856-424-8222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MB10544600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MB10544600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: