NPIMap

Individual provider Active NPI

Domenico Rotoli, DO

  • Internal Medicine Physician
  • Edgewater, NJ
National Provider Identifier
1760700215
Registry record updated Mar 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MB09391900 Issued in NJ
Practice address
103 River Rd
Suite 101
Edgewater, NJ 07020-1016
Phone
(201) 308-8995
Fax
(201) 917-3603
NPI assigned
May 7, 2010
Last updated
Mar 29, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MB09391900 NJ Primary

Addresses

Primary practice location

103 River Rd
Suite 101
Edgewater, NJ 07020-1016

Mailing address

103 River Rd
Suite 101
Edgewater, NJ 07020-1016
Phone (201) 308-8995

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150406000697 NJ Practitioner - Internal Medicine 6002134939 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Universal Medicine LLCGroup PAC ID 8224348388, 4 clinicians

Practice addresses (Care Compare)

103 River Rd
Suite 101
Edgewater, NJ 07020-1016
Phone (201) 308-8995

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Inhospital Physicians Corp of New Jersey, PC Internal Medicine CurrentSince Aug 14, 2024 Accepting new patients
Universal Medicine, LLC Internal Medicine CurrentSince Sep 9, 2015 Accepting new patients

Locations

103 River Rd
Ste 101
Edgewater, NJ 07020
Phone (201) 606-2592

350 Boulevard
Passaic, NJ 07055
Phone (973) 365-4300

610 Sentry Pkwy
Bldg 660
Blue Bell, PA 19422

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711670400000",
    "number": "1760700215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 RIVER RD",
            "address_2": "SUITE 101",
            "city": "EDGEWATER",
            "state": "NJ",
            "postal_code": "070201016",
            "telephone_number": "201-308-8995",
            "fax_number": "201-917-3603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 RIVER RD",
            "address_2": "SUITE 101",
            "city": "EDGEWATER",
            "state": "NJ",
            "postal_code": "070201016",
            "telephone_number": "201-308-8995",
            "fax_number": "201-917-3603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTOLI",
        "first_name": "DOMENICO",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-05-07",
        "last_updated": "2024-03-29",
        "certification_date": "2024-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MB09391900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewater, NJ

Sources for this page

Verify at the official NPI Registry.