Provider Demographics
NPI:1831204908
Name:ROCCO TUTELA MD PA
Entity type:Organization
Organization Name:ROCCO TUTELA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROCCO
Authorized Official - Middle Name:R
Authorized Official - Last Name:TUTELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-669-1240
Mailing Address - Street 1:347 MOUNT PLEASANT AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2724
Mailing Address - Country:US
Mailing Address - Phone:973-669-1240
Mailing Address - Fax:
Practice Address - Street 1:347 MOUNT PLEASANT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2724
Practice Address - Country:US
Practice Address - Phone:973-669-1240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJC52678208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ115455Medicare PIN
NJC52678Medicare UPIN