Provider Demographics
NPI:1942238225
Name:ROTH, JOSEPH MEYER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MEYER
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1130 MCBRIDE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3806
Mailing Address - Country:US
Mailing Address - Phone:973-785-2277
Mailing Address - Fax:973-785-2355
Practice Address - Street 1:925 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2724
Practice Address - Country:US
Practice Address - Phone:973-458-0408
Practice Address - Fax:973-405-6564
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA4776700207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1475304Medicaid
NJ538049Medicare UPIN
D19721Medicare UPIN