Healthcare Provider Details

I. General information

NPI: 1205857190
Provider Name (Legal Business Name): ROCCO J CRESCENZO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 N LOVELL DR
DUNNELLON FL
34433-4091
US

IV. Provider business mailing address

9601 N LOVELL DR
DUNNELLON FL
34433-4091
US

V. Phone/Fax

Practice location:
  • Phone: 610-246-5776
  • Fax: 610-539-8260
Mailing address:
  • Phone: 610-246-5776
  • Fax: 610-539-8260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberOS008171L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberOS22762
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: