Provider Demographics
NPI:1437181732
Name:ROCHE, DANIEL J (DPM)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:ROCHE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PROGRESS ST
Mailing Address - Street 2:STE B5
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1199
Mailing Address - Country:US
Mailing Address - Phone:908-753-0500
Mailing Address - Fax:908-753-0199
Practice Address - Street 1:4 PROGRESS ST
Practice Address - Street 2:STE B5
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1199
Practice Address - Country:US
Practice Address - Phone:908-753-0500
Practice Address - Fax:908-753-0199
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00153800213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45288Medicare UPIN
NJ452687MS7Medicare PIN