Provider Demographics
NPI:1225683642
Name:ROGERS, DANNICIOUS BAI
Entity Type:Individual
Prefix:
First Name:DANNICIOUS
Middle Name:BAI
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 W INGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-5014
Mailing Address - Country:US
Mailing Address - Phone:909-682-4618
Mailing Address - Fax:
Practice Address - Street 1:190 W INGHAM AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08638-5014
Practice Address - Country:US
Practice Address - Phone:909-682-4618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities