Provider Demographics
NPI:1205877370
Name:LA ROCCA, DARIO VITTORIO (MD)
Entity type:Individual
Prefix:
First Name:DARIO
Middle Name:VITTORIO
Last Name:LA ROCCA
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 1:2999 PRINCETON PIKE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3261
Mailing Address - Country:US
Mailing Address - Phone:609-406-1754
Mailing Address - Fax:
Practice Address - Street 1:2999 PRINCETON PIKE
Practice Address - Street 2:SUITE 5
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-3261
Practice Address - Country:US
Practice Address - Phone:609-406-1754
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0558762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ685644Medicare ID - Type Unspecified