Individual
MRS. KERRI E ROESCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPAC
Contact information
Practice address
34 COMMERCE AVE STE 2, RIVERHEAD, NY 11901-3118
(631) 722-8880
Mailing address
34 COMMERCE AVE, RIVERHEAD, NY 11901-3118
(631) 722-8880
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110004218
VA
363AM0700X
Medical Physician Assistant
Primary
014424-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03314707
—
NY
Enumeration date
11/02/2010
Last updated
05/16/2019
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