Provider Demographics
NPI:1700607470
Name:CONSTANCE ROCKLEIN
Entity type:Organization
Organization Name:CONSTANCE ROCKLEIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:CARC
Authorized Official - Phone:347-456-4564
Mailing Address - Street 1:5101 39TH AVE APT L41
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1138
Mailing Address - Country:US
Mailing Address - Phone:347-456-4564
Mailing Address - Fax:
Practice Address - Street 1:5101 39TH AVE APT L41
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11104-1138
Practice Address - Country:US
Practice Address - Phone:347-456-4564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable