MEDICARE: DR. ELIZABETH ANN ROCHE 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	207L00000X	Anesthesiology Physician	25MA07420300	NJ

General Provider Information

NPI Number	:	1861452229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH ANN ROCHE M.D.

Provider Business Mailing Address
First Line	:	577 CHESTNUT RIDGE RD
Second Line	:
City	:	WOODCLIFF LAKE
State	:	NJ
Zip	:	07677-8409
Country	:	US
Telephone Number	:	201-505-1020
Fax Number	:	201-505-1080

Provider Business Practice Location Address
First Line	:	577 CHESTNUT RIDGE RD
Second Line	:
City	:	WOODCLIFF LAKE
State	:	NJ
Zip	:	07677-8409
Country	:	US
Telephone Number	:	201-505-1020
Fax Number	:	201-505-1080

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

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	02/01/2016

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