Provider Demographics
NPI:1982249124
Name:ROCCO, LETICIA B (PA-C)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:B
Last Name:ROCCO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CEDAR ST
Mailing Address - Street 2:STE 6
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2031
Mailing Address - Country:US
Mailing Address - Phone:914-251-9110
Mailing Address - Fax:914-921-4877
Practice Address - Street 1:33 CEDAR ST STE 6
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2031
Practice Address - Country:US
Practice Address - Phone:914-251-9110
Practice Address - Fax:914-921-4877
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024859363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant