Provider Demographics
NPI:1548267628
Name:LAROCCA, SANDRO (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRO
Middle Name:
Last Name:LAROCCA
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 1:3131 PRINCETON PIKE
Mailing Address - Street 2:BUILDING 6, SUITE 106
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2201
Mailing Address - Country:US
Mailing Address - Phone:609-896-0020
Mailing Address - Fax:609-896-0041
Practice Address - Street 1:3131 PRINCETON PIKE
Practice Address - Street 2:BUILDING 6, SUITE 106
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2201
Practice Address - Country:US
Practice Address - Phone:609-896-0020
Practice Address - Fax:609-896-0041
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07275400174400000X
PAMD063167L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH14955Medicare UPIN
NJ054324L7UMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER