Provider Demographics
NPI:1134117245
Name:PASCUCCI, ROCCO F (MD)
Entity Type:Individual
Prefix:
First Name:ROCCO
Middle Name:F
Last Name:PASCUCCI
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 1:1 BETHANY RD
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1663
Mailing Address - Country:US
Mailing Address - Phone:732-264-0700
Mailing Address - Fax:732-264-1414
Practice Address - Street 1:1 BETHANY RD
Practice Address - Street 2:BUILDING 5; SUITE 65
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1663
Practice Address - Country:US
Practice Address - Phone:732-264-0700
Practice Address - Fax:732-264-1414
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46555208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7972202Medicaid
NJ7972202Medicaid