Provider Demographics
NPI:1053437368
Name:TUROCK, DAROLD ROBERT JR (LPN)
Entity type:Individual
Prefix:MR
First Name:DAROLD
Middle Name:ROBERT
Last Name:TUROCK
Suffix:JR
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 POTOMAC AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-1259
Mailing Address - Country:US
Mailing Address - Phone:716-883-1950
Mailing Address - Fax:
Practice Address - Street 1:288 POTOMAC AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1259
Practice Address - Country:US
Practice Address - Phone:716-883-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099726-1164W00000X
OHPN086707164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02770354Medicaid
OH2157240Medicaid