Healthcare Provider Details

I. General information

NPI: 1427481209
Provider Name (Legal Business Name): ROCCO MICHAEL BIANCO III RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 E WYOMING AVE
PHILADELPHIA PA
19124-3808
US

IV. Provider business mailing address

7734 HESSON LN
PENNSAUKEN NJ
08109-5604
US

V. Phone/Fax

Practice location:
  • Phone: 215-537-7660
  • Fax:
Mailing address:
  • Phone: 609-425-4617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number26NR12747600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: