Provider Demographics
NPI:1235296088
Name:TROCKI, IRA MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:MARK
Last Name:TROCKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:631 TILTON RD
Mailing Address - Street 2:PO BOX 865
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1219
Mailing Address - Country:US
Mailing Address - Phone:609-645-3000
Mailing Address - Fax:609-645-0253
Practice Address - Street 1:631 TILTON RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1219
Practice Address - Country:US
Practice Address - Phone:609-645-3000
Practice Address - Fax:609-645-0253
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03221500208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53273Medicare UPIN
NJ702732Medicare ID - Type Unspecified