Basic Information
| Provider Information | |||||||||
| NPI: | 1942238225 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROTH | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | MEYER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1130 MCBRIDE AVE FL 3 | ||||||||
| Address2: | |||||||||
| City: | WOODLAND PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074243806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737852277 | ||||||||
| FaxNumber: | 9737852355 | ||||||||
| Practice Location | |||||||||
| Address1: | 925 CLIFTON AVE | ||||||||
| Address2: | |||||||||
| City: | CLIFTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070132724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734580408 | ||||||||
| FaxNumber: | 9734056564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 04/27/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 25MA4776700 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 1475304 | 05 | NJ | MEDICAID |