Provider Demographics
NPI:1518775022
Name:ROTOLO, ANTHONY JR (PHD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:ROTOLO
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 1ST ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-6021
Mailing Address - Country:US
Mailing Address - Phone:315-316-1989
Mailing Address - Fax:
Practice Address - Street 1:34 OXFORD RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2669
Practice Address - Country:US
Practice Address - Phone:315-316-1989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No171400000XOther Service ProvidersHealth & Wellness Coach