Provider Demographics
NPI:1902854375
Name:THOMAS M ROCCHIO PODIATRY, LLC
Entity Type:Organization
Organization Name:THOMAS M ROCCHIO PODIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROCCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-437-1500
Mailing Address - Street 1:2895 HAMILTON BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-6172
Mailing Address - Country:US
Mailing Address - Phone:610-437-1500
Mailing Address - Fax:610-437-1555
Practice Address - Street 1:2895 HAMILTON BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6172
Practice Address - Country:US
Practice Address - Phone:610-437-1500
Practice Address - Fax:610-437-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2702885000OtherKEYSTONE
PA102214850-0001Medicaid
PA1845700OtherBLUE SHIELD
U95135Medicare UPIN
PA5928480001Medicare NSC
2702885000OtherKEYSTONE
PA1845700OtherBLUE SHIELD