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Contact Information

EDMUND J ROACHE MD
200 MULLIN STREET
SUITE 201
WATERTOWN, NY13601
 Phone: 315-785-8591
 Fax: 315-785-8591
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for EDMUND J ROACHE MD · (Female)

NPI # 1245265321
Status Active
Credentials
Entity Individual
Enumeration date 07/11/2006
Last updated 08/22/2020 - About 6 years ago
Sole proprietor 1 Not specified
Identifiers
  • NY License # 153941
  • NY Medicaid 00772743
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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