Provider Demographics
NPI:1922177922
Name:LAROCCA, GARY JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JOHN
Last Name:LAROCCA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DEWOLF RD STE 208
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7084
Mailing Address - Country:US
Mailing Address - Phone:201-497-6612
Mailing Address - Fax:201-497-6614
Practice Address - Street 1:1 DEWOLF RD STE 208
Practice Address - Street 2:
Practice Address - City:OLD TAPPAN
Practice Address - State:NJ
Practice Address - Zip Code:07675
Practice Address - Country:US
Practice Address - Phone:201-497-6612
Practice Address - Fax:201-497-6614
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00582100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ084540TBVMedicare UPIN