Provider Demographics
NPI:1689410946
Name:CORDEIRO, ROCHELLE COSTA
Entity type:Individual
Prefix:MRS
First Name:ROCHELLE
Middle Name:COSTA
Last Name:CORDEIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 MILLPOND DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:07848-3822
Mailing Address - Country:US
Mailing Address - Phone:551-316-1767
Mailing Address - Fax:
Practice Address - Street 1:239 NEW RD STE 103
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4274
Practice Address - Country:US
Practice Address - Phone:973-287-7234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ML00024900305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service