1710946447 NPI number — MICHAEL S ROGERS MD PA

Table of content: (NPI 1710946447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710946447 NPI number — MICHAEL S ROGERS MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL S ROGERS MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710946447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
831 KINGS HWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WEST DEPTFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08096-3162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-853-8730
Provider Business Mailing Address Fax Number:
856-853-8870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
831 KINGS HWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WEST DEPTFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08096-3162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-853-8730
Provider Business Practice Location Address Fax Number:
856-853-8870
Provider Enumeration Date:
03/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LARTHEY
Authorized Official First Name:
ELAINE
Authorized Official Middle Name:
Authorized Official Title or Position:
OM
Authorized Official Telephone Number:
856-853-8730

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000614452 . This is a "IBC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 000786022001 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6444407 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10872 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0762906002 . This is a "AMERIHEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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