Provider Demographics
NPI:1285692053
Name:DIPAOLA, ROCCO (MD)
Entity type:Individual
Prefix:
First Name:ROCCO
Middle Name:
Last Name:DIPAOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 RTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8007
Mailing Address - Country:US
Mailing Address - Phone:732-240-4787
Mailing Address - Fax:732-240-3114
Practice Address - Street 1:633 RTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8007
Practice Address - Country:US
Practice Address - Phone:732-240-4787
Practice Address - Fax:732-240-3114
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06405200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7228406Medicaid
NJ81970OtherAETNA
NJP00220374OtherRAILROAD MEDICARE
NJP00220374OtherRAILROAD MEDICARE
NJ900880BW9Medicare ID - Type UnspecifiedMEDICARE