Provider Demographics
NPI:1104965987
Name:HAAS, ROGER (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:HAAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 AMWELL RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1213
Mailing Address - Country:US
Mailing Address - Phone:908-874-3030
Mailing Address - Fax:908-874-4291
Practice Address - Street 1:331 ROUTE 206 STE 2B
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4781
Practice Address - Country:US
Practice Address - Phone:908-308-8016
Practice Address - Fax:732-463-6065
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03572900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE70669Medicare UPIN
NJ155494Medicare PIN