1417958158 NPI number — MR. JEFFREY J. ROCK DPM

Table of content: MR. JEFFREY J. ROCK DPM (NPI 1417958158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417958158 NPI number — MR. JEFFREY J. ROCK DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROCK
Provider First Name:
JEFFREY
Provider Middle Name:
J.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1417958158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
362 N BEDFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST BRIDGEWATER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02333-1148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
774-260-9720
Provider Business Mailing Address Fax Number:
774-260-9725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 COMMERCE BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
774-260-9720
Provider Business Practice Location Address Fax Number:
774-260-9725
Provider Enumeration Date:
08/03/2005

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: 213E00000X , with the licence number:  DPM 303 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 303 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 2068 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 2068 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0103X , with the licence number: 303 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 408233 . This is a "BCHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 9080028 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000002410 . This is a "B/C" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 003360201 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0660120001 . This is a "DME SUPPLIER NUMBER" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 454919 . This is a "TUFTS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 110094952A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27-02444 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 334210 . This is a "HARVARD PILGRIM HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 4211 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 480032461 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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