Provider Demographics
NPI:1174532873
Name:ROODA, GONTHAR S (DC)
Entity type:Individual
Prefix:DR
First Name:GONTHAR
Middle Name:S
Last Name:ROODA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 STATE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1421
Mailing Address - Country:US
Mailing Address - Phone:609-921-6056
Mailing Address - Fax:609-921-6056
Practice Address - Street 1:759 STATE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1421
Practice Address - Country:US
Practice Address - Phone:609-921-6056
Practice Address - Fax:609-921-6056
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ562483OtherAETNA #
NJ562483OtherAETNA #