Provider Demographics
NPI:1780977108
Name:JOLY, ROCHELLE (MD)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:JOLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROCHELLE
Other - Middle Name:
Other - Last Name:LINDENBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5925 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5009
Mailing Address - Country:US
Mailing Address - Phone:718-972-2700
Mailing Address - Fax:718-532-1724
Practice Address - Street 1:5925 15TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5009
Practice Address - Country:US
Practice Address - Phone:718-972-2700
Practice Address - Fax:718-532-1724
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD443300207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03963191Medicaid