Healthcare Provider Details

I. General information

NPI: 1407762461
Provider Name (Legal Business Name): ROCCO RINALDI-ROSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BAINBRIDGE ST
BROOKLYN NY
11233-1701
US

IV. Provider business mailing address

109 BAINBRIDGE ST
BROOKLYN NY
11233-1701
US

V. Phone/Fax

Practice location:
  • Phone: 917-972-0621
  • Fax:
Mailing address:
  • Phone: 917-972-0621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number132820
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: