Provider Demographics
NPI:1386947323
Name:ROCHE, IRENE ELIZABETH (PT)
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:ELIZABETH
Last Name:ROCHE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:60 PAUMANAKE AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-1910
Mailing Address - Country:US
Mailing Address - Phone:631-669-7526
Mailing Address - Fax:631-669-1999
Practice Address - Street 1:1428 5TH AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-4147
Practice Address - Country:US
Practice Address - Phone:631-665-1900
Practice Address - Fax:631-665-1377
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY013036-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist