Provider Demographics
NPI:1629060231
Name:LAROCHE, HAROLD IVANOVITCH (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:IVANOVITCH
Last Name:LAROCHE
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 1:236 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5563
Mailing Address - Country:US
Mailing Address - Phone:908-964-3257
Mailing Address - Fax:908-687-8866
Practice Address - Street 1:201 HWY 34 S
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-1902
Practice Address - Country:US
Practice Address - Phone:732-866-2284
Practice Address - Fax:732-866-1116
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61713207Q00000X
NJ25MA06171300207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7043007Medicaid
NJ7043007Medicaid
NJF36957Medicare UPIN
P00396017Medicare PIN