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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

NPI Number 1245265321
LBN Legal business name EDMUND J ROACHE MD
Authorized official EDMUND ROACHE - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 07/11/2006
Last updated 08/22/2020 - About 6 years ago
Identifiers
NY License # 153941
NY Medicaid 00772743
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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