Provider Demographics
NPI:1669813812
Name:ROKUSON, JODI M (AUD)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:M
Last Name:ROKUSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 FIRST AVENUE
Mailing Address - Street 2:APT. 3D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:973-650-0918
Mailing Address - Fax:
Practice Address - Street 1:1356 1ST AVE
Practice Address - Street 2:APT. 3D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4434
Practice Address - Country:US
Practice Address - Phone:973-650-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002460-1237600000X
NJA1YA00085000237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter