Provider Demographics
NPI:1851506216
Name:ROGERS, ELLEN RUTH (CTRS)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:RUTH
Last Name:ROGERS
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2836
Mailing Address - Country:US
Mailing Address - Phone:973-743-6573
Mailing Address - Fax:
Practice Address - Street 1:204 GROVE AVE
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1436
Practice Address - Country:US
Practice Address - Phone:973-571-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist