Provider Demographics
NPI:1114095759
Name:DENOBILE, ROCCO JR (PT)
Entity Type:Individual
Prefix:
First Name:ROCCO
Middle Name:
Last Name:DENOBILE
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2009
Mailing Address - Country:US
Mailing Address - Phone:718-904-9581
Mailing Address - Fax:718-931-0125
Practice Address - Street 1:3117 BUHRE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4738
Practice Address - Country:US
Practice Address - Phone:718-822-2281
Practice Address - Fax:718-597-8485
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026937-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133586197OtherTAX ID#
NYQ054G1Medicare PIN