Individual
MARISA J. ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1555 LONG POND RD, EMERGENCY CENTER, ROCHESTER, NY 14626-4122
(585) 723-7070
(585) 723-7083
Mailing address
1555 LONG POND RD, EMERGENCY CENTER, ROCHESTER, NY 14626-4122
(585) 723-7070
(585) 723-7083
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
012611
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03034177
—
NY
01
—
P01518713
MEDICARE RR
NY
Enumeration date
06/24/2008
Last updated
11/04/2015
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