Provider Demographics
NPI:1588635916
Name:ROTOLO, JAMES E (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:ROTOLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1696 ROUTE 88
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3030
Mailing Address - Country:US
Mailing Address - Phone:327-903-7655
Mailing Address - Fax:327-903-7622
Practice Address - Street 1:1696 ROUTE 88
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3030
Practice Address - Country:US
Practice Address - Phone:732-903-7655
Practice Address - Fax:732-903-7622
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA51934208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ736453DTSMedicare PIN
NJF35506Medicare UPIN
NJ901572Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER