Active NPI
Charles S. Roll, NCTMB, LMT
- Specialist
- Fanwood, NJ
National Provider Identifier
1689712291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA 16610
- Practice address
- 141 South Ave
Suite 5
Fanwood, NJ 07023-1224 - Phone
- (908) 322-0214
- NPI assigned
- Feb 3, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA 16610 | FL | Primary |
Addresses
Primary practice location
141 South Ave
Suite 5
Fanwood, NJ 07023-1224
Mailing address
141 South Ave
Suite 5
Fanwood, NJ 07023-1224
Phone (908) 322-0214
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA 16610 | FL | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689712291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "141 SOUTH AVE",
"address_2": "SUITE 5",
"city": "FANWOOD",
"state": "NJ",
"postal_code": "070231224",
"telephone_number": "908-322-0214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "141 SOUTH AVE",
"address_2": "SUITE 5",
"city": "FANWOOD",
"state": "NJ",
"postal_code": "070231224",
"telephone_number": "908-322-0214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROLL",
"first_name": "CHARLES",
"middle_name": "S.",
"name_prefix": "Mr.",
"credential": "NCTMB, LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "FL",
"license": "MA 16610",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fanwood, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.