Healthcare Provider Details

I. General information

NPI: 1871226027
Provider Name (Legal Business Name): JOHN JOSEPH ROTH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 KUSER RD STE 3
HAMILTON NJ
08691-3386
US

IV. Provider business mailing address

90 MATAWAN RD STE 302
MATAWAN NJ
07747-2653
US

V. Phone/Fax

Practice location:
  • Phone: 609-896-0444
  • Fax: 609-587-4349
Mailing address:
  • Phone: 732-441-7177
  • Fax: 732-441-7165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00388200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC007296
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC007296
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00388200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: