Provider Demographics
NPI:1295820629
Name:LAROCHE, GLADYS (MD)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:LAROCHE
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 BROADWAY DEPARTMENT OF MANAGED CARE ROOM 2B230
Mailing Address - Street 2:WOODHULL MEDICAL AND MENTAL HEALTH CENTER
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206
Mailing Address - Country:US
Mailing Address - Phone:718-963-8000
Mailing Address - Fax:718-630-3122
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:WOODHULL MEDICAL AND MENTAL HEALTH CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-963-8000
Practice Address - Fax:718-693-3724
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2014-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1595642080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine