Healthcare Provider Details

I. General information

NPI: 1982249124
Provider Name (Legal Business Name): LETICIA B ROCCO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N MAIN ST STE 3
NEW CITY NY
10956-4021
US

IV. Provider business mailing address

301 N MAIN ST STE 3
NEW CITY NY
10956-4021
US

V. Phone/Fax

Practice location:
  • Phone: 845-499-2017
  • Fax:
Mailing address:
  • Phone: 845-499-2017
  • Fax: 845-499-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number024859
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: