Provider Demographics
NPI:1275875122
Name:GEORGE, ROCHELLE
Entity type:Individual
Prefix:MISS
First Name:ROCHELLE
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7116 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1823
Mailing Address - Country:US
Mailing Address - Phone:718-307-1577
Mailing Address - Fax:718-307-1578
Practice Address - Street 1:7116 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1823
Practice Address - Country:US
Practice Address - Phone:718-307-1577
Practice Address - Fax:718-307-1578
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303207-1164W00000X
NY404785363LP0808X
CT14059363LP0808X
390200000X
TX1073754363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program