Provider Demographics
NPI:1346019841
Name:ROTH, CHAIM (RT (R)(CT))
Entity Type:Individual
Prefix:
First Name:CHAIM
Middle Name:
Last Name:ROTH
Suffix:
Gender:M
Credentials:RT (R)(CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 JUMPING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1002
Mailing Address - Country:US
Mailing Address - Phone:347-684-3120
Mailing Address - Fax:
Practice Address - Street 1:222 JUMPING BROOK DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1002
Practice Address - Country:US
Practice Address - Phone:347-684-3120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146N00000X, 156F00000X
NJ6564902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No156F00000XEye and Vision Services ProvidersTechnician/Technologist