MEDICARE: FRANK A. ROTELLA DO PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician

General Provider Information

NPI Number	:	1376611905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRANK A. ROTELLA DO PA

Provider Business Mailing Address
First Line	:	559 SUMMIT AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2701
Country	:	US
Telephone Number	:	201-653-5031
Fax Number	:	201-653-4677

Provider Business Practice Location Address
First Line	:	559 SUMMIT AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-2701
Country	:	US
Telephone Number	:	201-653-5031
Fax Number	:	201-653-4677

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FRANK A ROTELLA
Credential	:	DO
Telephone Number	:	201-653-5031

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	07/20/2010

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