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General NPI Number Information
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NPI Number | 1467541078
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Entity Type | Individual
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Provider Name | DANIEL JAY ROTH M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 1665 ELLINGTON RD
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-2778
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Country | US
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Telephone | 860-648-2447
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Fax |
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Provider Business Mailing Address
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Address Line | 1830 D YOUVILLE LN
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City | ATLANTA
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State | GA
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Zip | 30341-1460
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 81112
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License Number State | CT
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