Provider Demographics
NPI:1497215958
Name:ROGERS, DAVID T
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:T
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 1:75 ENGLE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2904
Mailing Address - Country:US
Mailing Address - Phone:201-541-8600
Mailing Address - Fax:201-541-8100
Practice Address - Street 1:75 ENGLE ST FL 2
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2904
Practice Address - Country:US
Practice Address - Phone:201-541-8600
Practice Address - Fax:201-541-8100
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program