Provider Demographics
NPI:1447387907
Name:ROCHA, GARY (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:ROCHA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E 27TH ST
Mailing Address - Street 2:APT 9
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-9272
Mailing Address - Country:US
Mailing Address - Phone:917-769-6800
Mailing Address - Fax:718-462-7997
Practice Address - Street 1:322 E RTE 4
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5105
Practice Address - Country:US
Practice Address - Phone:201-489-8868
Practice Address - Fax:248-827-0949
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5920152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02831478Medicaid
NYA300042703Medicare PIN