Provider Demographics
NPI:1508193079
Name:ROIG, DANIEL ADAM (DPT)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ADAM
Last Name:ROIG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2836
Mailing Address - Country:US
Mailing Address - Phone:973-761-0077
Mailing Address - Fax:973-761-0024
Practice Address - Street 1:177 VALLEY ST
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2836
Practice Address - Country:US
Practice Address - Phone:973-761-0077
Practice Address - Fax:973-761-0024
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01335000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01335000OtherNEW JERSEY STATE PHYSICAL THERAPIST LICENSE