Provider Demographics
NPI:1194086140
Name:ROACH, LINDSEY
Entity type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:
Last Name:ROACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8309 TALBOT ST APT 1L
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3506
Mailing Address - Country:US
Mailing Address - Phone:917-576-7456
Mailing Address - Fax:
Practice Address - Street 1:8309 TALBOT ST APT 1L
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-3506
Practice Address - Country:US
Practice Address - Phone:917-576-7456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY544125111174400000X
NY544126111174400000X
NY346444091174400000X
NY346443091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist