Healthcare Provider Details

I. General information

NPI: 1942238225
Provider Name (Legal Business Name): JOSEPH MEYER ROTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 CLIFTON AVE
CLIFTON NJ
07013-2724
US

IV. Provider business mailing address

1130 MCBRIDE AVE FL 3
WOODLAND PARK NJ
07424-3806
US

V. Phone/Fax

Practice location:
  • Phone: 973-458-0408
  • Fax: 973-405-6564
Mailing address:
  • Phone: 973-785-2277
  • Fax: 973-785-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA4776700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: