Provider Demographics
NPI:1972179364
Name:ROCK, CLEOTIELDE NADIA
Entity Type:Individual
Prefix:
First Name:CLEOTIELDE
Middle Name:NADIA
Last Name:ROCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-2008
Mailing Address - Country:US
Mailing Address - Phone:914-965-5305
Mailing Address - Fax:914-963-7187
Practice Address - Street 1:317 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-2008
Practice Address - Country:US
Practice Address - Phone:914-965-5305
Practice Address - Fax:914-963-7187
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179349-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse