MEDICARE: DR. HAROLD IVANOVITCH LAROCHE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MA61713	NJ
2	207P00000X	Emergency Medicine Physician	25MA06171300	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629060231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAROLD IVANOVITCH LAROCHE M.D.

Provider Business Mailing Address
First Line	:	236 PARKSIDE DR
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-5563
Country	:	US
Telephone Number	:	908-964-3257
Fax Number	:	908-687-8866

Provider Business Practice Location Address
First Line	:	201 HWY 34 S
Second Line	:
City	:	COLTS NECK
State	:	NJ
Zip	:	07722-1902
Country	:	US
Telephone Number	:	732-866-2284
Fax Number	:	732-866-1116

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	07/06/2023

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Directions to “ DR. HAROLD IVANOVITCH LAROCHE M.D.” Practice Location

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