Provider Demographics
NPI:1417958158
Name:ROCK, JEFFREY J (DPM)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:J
Last Name:ROCK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 N BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1148
Mailing Address - Country:US
Mailing Address - Phone:774-260-9720
Mailing Address - Fax:774-260-9725
Practice Address - Street 1:8 COMMERCE BLVD.
Practice Address - Street 2:
Practice Address - City:MIDDLEBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02346
Practice Address - Country:US
Practice Address - Phone:774-260-9720
Practice Address - Fax:774-260-9725
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDPM 303213E00000X
RI303213E00000X, 213ES0103X
MA2068213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI408233OtherBCHIP
RI9080028Medicaid
RI0000002410OtherB/C
MA003360201OtherMEDICARE PTAN
RI0660120001OtherDME SUPPLIER NUMBER
RI454919OtherTUFTS
MA110094952AMedicaid
RI27-02444OtherUNITED HEALTH CARE
RI334210OtherHARVARD PILGRIM HEALTH
RI4211OtherNEIGHBORHOOD HEALTH
RI480032461OtherRAILROAD MEDICARE
MA110094952AMedicaid
RI4211OtherNEIGHBORHOOD HEALTH