Healthcare Provider Details

I. General information

NPI: 1750949798
Provider Name (Legal Business Name): DAUDA M ROGERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 10/11/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 ROUTE 35
EATONTOWN NJ
07724
US

IV. Provider business mailing address

135 ROUTE 35
EATONTOWN NJ
07724
US

V. Phone/Fax

Practice location:
  • Phone: 848-300-2210
  • Fax: 848-300-2207
Mailing address:
  • Phone: 848-300-2210
  • Fax: 848-300-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA11574200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: