Physician Compare National (NPI:1760700215)

HEALTHCARE PROVIDER: DOMENICO ROTOLI DO

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1760700215
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6002134939
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150406000697
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ROTOLI
	Individual professional last name
Provider First Name	DOMENICO
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2010
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	103 RIVER RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 101
	Group Practice or individual's line 2 address
City	EDGEWATER
	Group Practice or individual's city
State	NJ
	Group Practice or individual's state
Zip Code	070201016
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	310003
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HACKENSACKUMC PALISADES
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	310006
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST MARY'S GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y