Healthcare Provider Details

I. General information

NPI: 1588820435
Provider Name (Legal Business Name): JUAN PABLO ROCCA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 04/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST ROSENTHAL C, 2ND FLOOR
BRONX NY
10467-2401
US

IV. Provider business mailing address

111 E 210TH ST ROSENTHAL C, 2ND FLOOR
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-5909
  • Fax: 718-547-4773
Mailing address:
  • Phone: 718-920-5909
  • Fax: 718-547-4773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number003443
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number003443
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: