Healthcare Provider Details

I. General information

NPI: 1629060231
Provider Name (Legal Business Name): HAROLD IVANOVITCH LAROCHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HWY 34 S
COLTS NECK NJ
07722-1902
US

IV. Provider business mailing address

236 PARKSIDE DR
UNION NJ
07083-5563
US

V. Phone/Fax

Practice location:
  • Phone: 732-866-2284
  • Fax: 732-866-1116
Mailing address:
  • Phone: 908-964-3257
  • Fax: 908-687-8866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA61713
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA06171300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: