Healthcare Provider Details

I. General information

NPI: 1013104439
Provider Name (Legal Business Name): GREGORY JOSEPH ROKOSZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2007
Last Update Date: 09/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 OLD SHORT HILLS RD
LIVINGSTON NJ
07039-5672
US

IV. Provider business mailing address

8 WILDLIFE RUN
BOONTON NJ
07005-9043
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-5733
  • Fax: 973-322-8360
Mailing address:
  • Phone: 973-335-0122
  • Fax: 973-335-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MB03949500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: