Provider Demographics
NPI:1205025574
Name:ROTH, ANNE G (DO)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:G
Last Name:ROTH
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1944 STATE ROUTE 33
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4862
Mailing Address - Country:US
Mailing Address - Phone:732-776-4178
Mailing Address - Fax:732-776-4946
Practice Address - Street 1:1944 STATE ROUTE 33
Practice Address - Street 2:SUITE 101A
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4862
Practice Address - Country:US
Practice Address - Phone:732-776-4178
Practice Address - Fax:732-776-4946
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2010-11-23
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB083246002080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ118873UWHMedicare PIN