Provider Demographics
NPI:1295718591
Name:TETRO, ROCCO (DC)
Entity type:Individual
Prefix:DR
First Name:ROCCO
Middle Name:
Last Name:TETRO
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 1:445 W 50TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6521
Mailing Address - Country:US
Mailing Address - Phone:212-581-9199
Mailing Address - Fax:212-581-1114
Practice Address - Street 1:445 W 50TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6521
Practice Address - Country:US
Practice Address - Phone:212-581-9199
Practice Address - Fax:212-581-1114
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009486-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX2D663Medicare PIN
NJU79081Medicare UPIN