Healthcare Provider Details

I. General information

NPI: 1124807797
Provider Name (Legal Business Name): GERARD C ROKOSZ LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 S 5TH AVE
HIGHLAND PARK NJ
08904-2604
US

IV. Provider business mailing address

27 S 5TH AVE
HIGHLAND PARK NJ
08904-2604
US

V. Phone/Fax

Practice location:
  • Phone: 732-825-7729
  • Fax:
Mailing address:
  • Phone: 732-825-7729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06986700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: