1609937655 NPI number — ELSIE ROCA-PICCINI

Table of content: ELSIE ROCA-PICCINI (NPI 1609937655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609937655 NPI number — ELSIE ROCA-PICCINI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROCA-PICCINI
Provider First Name:
ELSIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609937655
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
317 GEORGE ST
Provider Second Line Business Mailing Address:
UNIVERSITY MEDICAL GROUP 3RD FLOOR
Provider Business Mailing Address City Name:
NEW BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08901-2008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-235-8282
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 WORLDS FAIR DR
Provider Second Line Business Practice Location Address:
ROBERT WOOD JOHNSON UNIVERSITY MEDICAL GROUP - SOMERSET
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08873-1344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-743-5437
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MA68300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 25MA06830000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8238804 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".