Healthcare Provider Details

I. General information

NPI: 1174596944
Provider Name (Legal Business Name): JAMES J. ROGERS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CENTURY PKWY STE 350
MOUNT LAUREL NJ
08054-1149
US

IV. Provider business mailing address

356 GRANDE BLVD
GLASSBORO NJ
08028-3242
US

V. Phone/Fax

Practice location:
  • Phone: 856-482-9000
  • Fax: 856-482-1159
Mailing address:
  • Phone: 856-520-9951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMB05852300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: