=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679654008
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS F. ROCERETO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 08/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 CENTENNIAL BLVD
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-4689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-325-6644
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 COOPER PLZ SUITE 502
-----------------------------------------------------
City | CAMDEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08103-1438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-963-6888
-----------------------------------------------------
Fax | 856-968-8499
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VX0201X
-----------------------------------------------------
Taxonomy Name | Gynecologic Oncology Physician
-----------------------------------------------------
License Number | MA23746
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------