Provider Demographics
NPI:1205951183
Name:ROTUNDO, JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:ROTUNDO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 NEWARK ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4548
Mailing Address - Country:US
Mailing Address - Phone:201-656-5600
Mailing Address - Fax:201-656-6533
Practice Address - Street 1:51 NEWARK ST
Practice Address - Street 2:SUITE 203
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4548
Practice Address - Country:US
Practice Address - Phone:201-656-5600
Practice Address - Fax:201-656-6533
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X, 225100000X
NJ38MC00540700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU73772Medicare UPIN
NJ035890Medicare ID - Type Unspecified