Provider Demographics
NPI:1801991393
Name:ROTELLA, FRANK ANTHONY (DO)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:ANTHONY
Last Name:ROTELLA
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 1:600 PAVONIA AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2929
Mailing Address - Country:US
Mailing Address - Phone:201-216-3030
Mailing Address - Fax:201-499-0247
Practice Address - Street 1:600 PAVONIA AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2929
Practice Address - Country:US
Practice Address - Phone:201-216-3030
Practice Address - Fax:201-499-0247
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB25053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8375305Medicaid
NJ8375305Medicaid
NJ043887Medicare ID - Type Unspecified