Provider Demographics
NPI:1568517449
Name:ROCKTASHEL, MARIA (MSN)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:ROCKTASHEL
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:MS
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:ROCKTASHEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:1715 MAIN ST
Mailing Address - Street 2:UNIT 5
Mailing Address - City:LAKE COMO
Mailing Address - State:NJ
Mailing Address - Zip Code:07719
Mailing Address - Country:US
Mailing Address - Phone:484-802-6310
Mailing Address - Fax:
Practice Address - Street 1:425 JACK MARTIN BLVD
Practice Address - Street 2:WOMEN'S IMAGING PAVILION
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-836-4672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00318900363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ16523Medicare UPIN
PA079467Medicare ID - Type Unspecified