Provider Demographics
NPI:1225172554
Name:ROCKSMITH, EUGENIO R (MD)
Entity Type:Individual
Prefix:
First Name:EUGENIO
Middle Name:R
Last Name:ROCKSMITH
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 356
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-0356
Mailing Address - Country:US
Mailing Address - Phone:856-896-2042
Mailing Address - Fax:856-896-2536
Practice Address - Street 1:1237 W SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6920
Practice Address - Country:US
Practice Address - Phone:856-896-2042
Practice Address - Fax:856-896-2536
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA078168002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0071226Medicaid
NJ086000ZB8WMedicare PIN
NJH52256Medicare UPIN