Healthcare Provider Details

I. General information

NPI: 1285999003
Provider Name (Legal Business Name): MORDECAI J ROKEACH MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1091-EAST 22 ST
BROOKLYN NY
11210-3619
US

IV. Provider business mailing address

1091-EAST 22STREET
BROOKLYN NY
11210
US

V. Phone/Fax

Practice location:
  • Phone: 917-903-7120
  • Fax: 718-258-5471
Mailing address:
  • Phone: 917-903-7120
  • Fax: 718-258-5471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: