Provider Demographics
NPI:1760457436
Name:ROCHE, KEVIN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOSEPH
Last Name:ROCHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5388
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-0388
Mailing Address - Country:US
Mailing Address - Phone:908-735-4477
Mailing Address - Fax:908-735-6532
Practice Address - Street 1:1 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:NJ
Practice Address - Zip Code:08801-3101
Practice Address - Country:US
Practice Address - Phone:908-735-4477
Practice Address - Fax:908-735-6532
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA074954002085P0229X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9019600Medicaid
NJ067868A5KMedicare ID - Type Unspecified
NJE82404Medicare UPIN