Provider Demographics
NPI:1114673142
Name:ADAMS, ROGER D (DPT)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:D
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:ROGER
Other - Middle Name:D
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:1441 E 101ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5507
Mailing Address - Country:US
Mailing Address - Phone:347-586-4191
Mailing Address - Fax:
Practice Address - Street 1:384 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5210
Practice Address - Country:US
Practice Address - Phone:347-586-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034866-01225100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist