Provider Demographics
NPI:1114955259
Name:ROACH, NEIL A (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:A
Last Name:ROACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WHITE HORSE PIKE
Mailing Address - Street 2:SUITE 9, HEIGHTS IMAGING CENTER
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1299
Mailing Address - Country:US
Mailing Address - Phone:856-546-1177
Mailing Address - Fax:856-546-0666
Practice Address - Street 1:17 WHITE HORSE PIKE
Practice Address - Street 2:STE 9
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1299
Practice Address - Country:US
Practice Address - Phone:856-546-1177
Practice Address - Fax:856-546-0666
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052730L2085R0202X
NJ25MA052273002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014666080020Medicaid
PA0716985000OtherIBC KHPE
PA001466608Medicaid
NJP00390756OtherRRMC
PAP00403104OtherRRMC
PAPA7584OtherHEALTHNET
PA231955165OtherAETNA USHC
PA001466608OtherAMERICHOICE OF PA
PA231955165OtherINTERGROUP SERVICES
NJ6185703Medicaid
PA034628OtherHIGHMARK BLUE SHIELD
PA367605OtherPHCS
PAMD052730LOtherHEALTH PARTNERS
PA30035147OtherKEYSTONE MERCY
PAMD052730LOtherHEALTH PARTNERS
PA0014666080020Medicaid
PA001466608Medicaid
PA001466608Medicaid