Provider Demographics
NPI:1952398935
Name:ROCKWELL, BRUCE
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:ROCKWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 CHURCHILL HUBBARD RD
Mailing Address - Street 2:4TH FLOOR, SUITE 401
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1375
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:779 FAIRMOUNT AVE
Practice Address - Street 2:4TH FLOOR, SUITE 401
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-2608
Practice Address - Country:US
Practice Address - Phone:716-708-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18787512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1878750CROtherWORKERS COMPENSATION
NY01732503Medicaid
NY300074197OtherRAILROAD MEDICARE
NY01732503Medicaid
NY300074197OtherRAILROAD MEDICARE
NY52050MMedicare ID - Type Unspecified