Provider Demographics
NPI:1104362623
Name:ROCK-GANGALE, JAYNE (OT)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:ROCK-GANGALE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4926
Mailing Address - Country:US
Mailing Address - Phone:973-495-8409
Mailing Address - Fax:973-337-5327
Practice Address - Street 1:194 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4926
Practice Address - Country:US
Practice Address - Phone:973-495-8409
Practice Address - Fax:973-337-5327
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-07
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00222200172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker