Active NPI
Jeffrey Paul Roach, PH.D.
- Clinical Psychologist
- Tonawanda, NY
National Provider Identifier
1114949351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 011900
- Practice address
- 884 Brighton Rd
Tonawanda, NY 14150-8169 - Phone
- (716) 836-9460
- NPI assigned
- Jul 24, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 011900 | NY | Primary |
Addresses
Primary practice location
884 Brighton Rd
Tonawanda, NY 14150-8169
Mailing address
884 Brighton Rd
Tonawanda, NY 14150-8169
Phone (716) 836-9460
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101229000482 | NY | Practitioner - Clinical Psychologist | 9638367097 | Practice locations: Tonawanda, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011900 | NY | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114949351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "884 BRIGHTON RD",
"city": "TONAWANDA",
"state": "NY",
"postal_code": "141508169",
"telephone_number": "716-836-9460"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "884 BRIGHTON RD",
"city": "TONAWANDA",
"state": "NY",
"postal_code": "141508169",
"telephone_number": "716-836-9460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROACH",
"first_name": "JEFFREY",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "011900",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tonawanda, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.