Provider Demographics
NPI:1811171556
Name:ROC, MARIE LUDY (RN)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:LUDY
Last Name:ROC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 WOODSTOCK ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4442
Mailing Address - Country:US
Mailing Address - Phone:516-568-0411
Mailing Address - Fax:
Practice Address - Street 1:1629 WOODSTOCK ST
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4442
Practice Address - Country:US
Practice Address - Phone:516-633-3887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6650469163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01542112Medicaid