Healthcare Provider Details

I. General information

NPI: 1760457436
Provider Name (Legal Business Name): KEVIN JOSEPH ROCHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DOGWOOD DR
ANNANDALE NJ
08801-3101
US

IV. Provider business mailing address

PO BOX 5388
CLINTON NJ
08809-0388
US

V. Phone/Fax

Practice location:
  • Phone: 908-735-4477
  • Fax: 908-735-6532
Mailing address:
  • Phone: 908-735-4477
  • Fax: 908-735-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number25MA07495400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA07495400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: