Provider Demographics
NPI:1497724868
Name:ROSCOE, RICHARD J (PT CHT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
Last Name:ROSCOE
Suffix:
Gender:M
Credentials:PT CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16 TIMBER WOLF DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08620-1331
Mailing Address - Country:US
Mailing Address - Phone:609-213-6287
Mailing Address - Fax:609-581-2606
Practice Address - Street 1:325 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1617
Practice Address - Country:US
Practice Address - Phone:609-924-8131
Practice Address - Fax:609-924-8535
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00177800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ462567VDEMedicare ID - Type Unspecified