Healthcare Provider Details

I. General information

NPI: 1780977108
Provider Name (Legal Business Name): ROCHELLE JOLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROCHELLE LINDENBAUM MD

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 15TH AVE
BROOKLYN NY
11219-5009
US

IV. Provider business mailing address

5925 15TH AVE
BROOKLYN NY
11219-5009
US

V. Phone/Fax

Practice location:
  • Phone: 718-972-2700
  • Fax: 718-532-1724
Mailing address:
  • Phone: 718-972-2700
  • Fax: 718-532-1724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD443300
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: