Provider Demographics
NPI:1922215250
Name:ROTONDI, JOHN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:ROTONDI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 NEWARK AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-4122
Mailing Address - Country:US
Mailing Address - Phone:973-759-0110
Mailing Address - Fax:973-759-0153
Practice Address - Street 1:36 NEWARK AVE STE 320
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-4122
Practice Address - Country:US
Practice Address - Phone:973-759-0110
Practice Address - Fax:973-759-0153
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00148200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ765OtherCONSOLIDATED SERVICES GRP
NJ070OtherEMPIREHEALTHCHOICE (CA)
NJ70010000ZDY528OtherBLUECROSSBLUESHIELD MA
NJW880324776OtherPMA INS. GRP BLUEBELL, PA
NJSANR-954146179OtherMHN SERV SANRAFAEL,CA
NJRO451022Medicare ID - Type Unspecified