Provider Demographics
NPI:1760459085
Name:ROTH, PATRICK A (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:A
Last Name:ROTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 FROM RD STE 220
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3551
Mailing Address - Country:US
Mailing Address - Phone:201-342-2550
Mailing Address - Fax:201-342-7171
Practice Address - Street 1:650 FROM RD STE 220
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3551
Practice Address - Country:US
Practice Address - Phone:201-342-2550
Practice Address - Fax:201-342-7171
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06064600207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1760459085OtherNPI
NJF86282Medicare UPIN