Provider Demographics
NPI:1326345646
Name:ROCCA, PETER JAMES (LPN)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:JAMES
Last Name:ROCCA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-2636
Mailing Address - Country:US
Mailing Address - Phone:631-592-8483
Mailing Address - Fax:
Practice Address - Street 1:554 17TH ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-2636
Practice Address - Country:US
Practice Address - Phone:631-592-8483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267225164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse