Provider Demographics
NPI:1730499120
Name:ROCKIS, EDWARD THOMAS (SLP)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:THOMAS
Last Name:ROCKIS
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 74TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1401
Mailing Address - Country:US
Mailing Address - Phone:917-747-3210
Mailing Address - Fax:
Practice Address - Street 1:3029 74TH ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1401
Practice Address - Country:US
Practice Address - Phone:917-747-3210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011038-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist