Provider Demographics
NPI:1467991471
Name:ROGERS, PATRICK (DO)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:ROGERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LEONARDO
Mailing Address - State:NJ
Mailing Address - Zip Code:07737-1016
Mailing Address - Country:US
Mailing Address - Phone:732-673-1604
Mailing Address - Fax:
Practice Address - Street 1:40 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LEONARDO
Practice Address - State:NJ
Practice Address - Zip Code:07737-1016
Practice Address - Country:US
Practice Address - Phone:732-673-1604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10028200207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine