Healthcare Provider Details

I. General information

NPI: 1114677184
Provider Name (Legal Business Name): ROCHELLE R ENRIQUEZ MAGNO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 VALLEY RD
MONTCLAIR NJ
07042-2212
US

IV. Provider business mailing address

93 ERIE STREET STORE FRONT
JERSEY CITY NJ
07302
US

V. Phone/Fax

Practice location:
  • Phone: 657-229-5274
  • Fax:
Mailing address:
  • Phone: 657-229-5274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: