Provider Demographics
NPI:1538132352
Name:ROTH, DANIEL B (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:B
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1700 GALLOPING HILL RD
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1303
Mailing Address - Country:US
Mailing Address - Phone:908-458-8334
Mailing Address - Fax:908-298-0104
Practice Address - Street 1:10 PLUM ST
Practice Address - Street 2:SUITE 600
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2065
Practice Address - Country:US
Practice Address - Phone:732-220-1600
Practice Address - Fax:732-220-1603
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2017-08-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ71092207W00000X
NJ25MA07109200207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G76421Medicare UPIN