Healthcare Provider Details

I. General information

NPI: 1801770243
Provider Name (Legal Business Name): YUSEF ROACH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33-41 NEWARK ST
HOBOKEN NJ
07030-5627
US

IV. Provider business mailing address

33-41 NEWARK ST
HOBOKEN NJ
07030-5627
US

V. Phone/Fax

Practice location:
  • Phone: 732-907-0470
  • Fax:
Mailing address:
  • Phone: 732-907-0470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: