Provider Demographics
NPI:1306990007
Name:DANIEL LAROCHE, MD, PC
Entity type:Organization
Organization Name:DANIEL LAROCHE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-693-0700
Mailing Address - Street 1:1100 SHAMES DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1765
Mailing Address - Country:US
Mailing Address - Phone:516-693-0700
Mailing Address - Fax:516-693-0271
Practice Address - Street 1:21543 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1736
Practice Address - Country:US
Practice Address - Phone:718-217-0424
Practice Address - Fax:718-217-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202107207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01749444Medicaid
NY4241630001Medicare NSC
NYG34486Medicare UPIN
NY02534Medicare ID - Type Unspecified