Provider Demographics
NPI:1376611905
Name:FRANK A. ROTELLA DO PA
Entity Type:Organization
Organization Name:FRANK A. ROTELLA DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-653-5031
Mailing Address - Street 1:559 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2701
Mailing Address - Country:US
Mailing Address - Phone:201-653-5031
Mailing Address - Fax:201-653-4677
Practice Address - Street 1:559 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2701
Practice Address - Country:US
Practice Address - Phone:201-653-5031
Practice Address - Fax:201-653-4677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C53984Medicare UPIN
NJ459899Medicare ID - Type Unspecified