Healthcare Provider Details

I. General information

NPI: 1073218525
Provider Name (Legal Business Name): FRANKLIN ROQUE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 WASHINGTON AVE
WESTWOOD NJ
07675-2000
US

IV. Provider business mailing address

93 HEMLOCK DR
PARAMUS NJ
07652-3341
US

V. Phone/Fax

Practice location:
  • Phone: 201-664-1118
  • Fax:
Mailing address:
  • Phone: 201-925-0762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02147400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: