Healthcare Provider Details

I. General information

NPI: 1851391429
Provider Name (Legal Business Name): MARC ROELKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 MOUNT PLEASANT AVE
WEST ORANGE NJ
07052-2724
US

IV. Provider business mailing address

375 MOUNT PLEASANT AVE
WEST ORANGE NJ
07052-2724
US

V. Phone/Fax

Practice location:
  • Phone: 973-731-9442
  • Fax: 973-731-2918
Mailing address:
  • Phone: 973-731-9442
  • Fax: 973-731-2918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA06062900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMA60629
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: