MEDICARE: KATHLEEN ROCHE FNP

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	363LF0000X	Family Nurse Practitioner	266634	NY

General Provider Information

NPI Number	:	1871804559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ROCHE FNP

Provider Business Mailing Address
First Line	:	1735 YORK AVE
Second Line	:	APT 23B
City	:	NEW YORK
State	:	NY
Zip	:	10128-6855
Country	:	US
Telephone Number	:	201-956-1505
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 YORK AVE
Second Line	:	APT 23
City	:	NEW YORK
State	:	NY
Zip	:	10128-6855
Country	:	US
Telephone Number	:	201-956-1505
Fax Number	:

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

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	06/28/2010

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