Provider Demographics
NPI:1760700215
Name:ROTOLI, DOMENICO (DO)
Entity Type:Individual
Prefix:DR
First Name:DOMENICO
Middle Name:
Last Name:ROTOLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 RIVER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1016
Mailing Address - Country:US
Mailing Address - Phone:201-308-8995
Mailing Address - Fax:201-917-3603
Practice Address - Street 1:103 RIVER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1016
Practice Address - Country:US
Practice Address - Phone:201-308-8995
Practice Address - Fax:201-917-3603
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09391900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine