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General NPI Number Information
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NPI Number | 1780156307
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Entity Type | Organization
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Legal Business Name | JEFFREY L ROCKMORE MD PC
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Dates
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Enumeration Date | 12/20/2018
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Last Update Date | 04/17/2020
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Provider Practice Location Address
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Address Line | 15 OLD LOUDON RD
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City | LATHAM
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State | NY
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Zip | 12110-5242
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Country | US
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Telephone | 518-366-3783
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Fax |
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Provider Business Mailing Address
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Address Line | 15 OLD LOUDON RD
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City | LATHAM
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State | NY
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Zip | 12110-5242
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY L ROCKMORE
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Credential | MD
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Telephone | 518-366-3783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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