Provider Demographics
NPI:1114912375
Name:ROCCAFORTE, J DAVID (MD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:DAVID
Last Name:ROCCAFORTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:LA SAL
Mailing Address - State:UT
Mailing Address - Zip Code:84530-0252
Mailing Address - Country:US
Mailing Address - Phone:917-216-1595
Mailing Address - Fax:
Practice Address - Street 1:652 BROADWAY APT 10F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2334
Practice Address - Country:US
Practice Address - Phone:917-216-1595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208415207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02111237Medicaid
NY39B081Medicare PIN
NYG94467Medicare UPIN