Healthcare Provider Details

I. General information

NPI: 1467415042
Provider Name (Legal Business Name): JEFFREY D ROFFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 GILBERT ST N
TINTON FALLS NJ
07701
US

IV. Provider business mailing address

43 GILBERT ST N
TINTON FALLS NJ
07701
US

V. Phone/Fax

Practice location:
  • Phone: 732-747-0900
  • Fax: 732-758-8907
Mailing address:
  • Phone: 732-747-0900
  • Fax: 732-758-8907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number25MA02985400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: