Provider Demographics
NPI:1639371628
Name:ROCHA, LAURO LUCIO (APRN,BC)
Entity Type:Individual
Prefix:MR
First Name:LAURO
Middle Name:LUCIO
Last Name:ROCHA
Suffix:
Gender:M
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 W SIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-1618
Mailing Address - Country:US
Mailing Address - Phone:201-434-7800
Mailing Address - Fax:201-434-6715
Practice Address - Street 1:562 W SIDE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-1618
Practice Address - Country:US
Practice Address - Phone:201-434-7800
Practice Address - Fax:201-434-6715
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00133200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1194996645Other444 WILLIAM STREET
NJ1740345693Other741 BROADWAY
NJ151971Medicaid
NJ1235300799Other37 N DAY
NJ1932370483Other101 LUDLOW STREET
NJ1235300799Other37 N DAY
NJ222747589OtherNCHC EIN