Organization
ANDREAS D. ROTSIDES, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREAS D ROTSIDES MD (OWNER)
(973) 328-1040
Entity
Organization
Contact information
Practice address
195 US HIGHWAY 46, SUITE 200, MINE HILL, NJ 07803-3163
(973) 328-1040
(973) 328-1544
Mailing address
195 US HIGHWAY 46, SUITE 200, MINE HILL, NJ 07803-3163
(973) 328-1040
(973) 328-1544
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA05010400
NJ
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
25MA05010400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0077241
—
NJ
01
—
2352899001
AMERIHEALTH GROUP ID
NJ
01
—
DG4164
RAILROAD MEDICARE GRP
NJ
Enumeration date
04/16/2006
Last updated
09/08/2009
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