Provider Demographics
NPI:1316964752
Name:ROCAMBOLI, DAVID (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ROCAMBOLI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 ADAMS ST
Mailing Address - Street 2:APT 509
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-9019
Mailing Address - Country:US
Mailing Address - Phone:917-873-6284
Mailing Address - Fax:973-893-0135
Practice Address - Street 1:1100 ADAMS ST
Practice Address - Street 2:APT 509
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-9019
Practice Address - Country:US
Practice Address - Phone:917-873-6284
Practice Address - Fax:973-893-0135
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA79029207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0077364Medicaid
NJ092305DFHMedicare ID - Type Unspecified
NJ0077364Medicaid