Provider Demographics
NPI:1669855565
Name:ROTOLI MEDICAL CONSULTANTS LLC
Entity type:Organization
Organization Name:ROTOLI MEDICAL CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMENICO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DO,
Authorized Official - Phone:551-486-6388
Mailing Address - Street 1:424 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-2857
Mailing Address - Country:US
Mailing Address - Phone:201-222-9370
Mailing Address - Fax:201-222-9392
Practice Address - Street 1:103 RIVER RD STE 1B
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1016
Practice Address - Country:US
Practice Address - Phone:201-222-9370
Practice Address - Fax:201-222-9392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09391900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MB09391900OtherMEDICAL LICENSE