Healthcare Provider Details

I. General information

NPI: 1760459085
Provider Name (Legal Business Name): PATRICK A ROTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 FROM RD STE 220
PARAMUS NJ
07652-3551
US

IV. Provider business mailing address

650 FROM RD STE 220
PARAMUS NJ
07652-3551
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-2550
  • Fax: 201-342-7171
Mailing address:
  • Phone: 201-342-2550
  • Fax: 201-342-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number25MA06064600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1760459085
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerNPI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: