Healthcare Provider Details

I. General information

NPI: 1326005448
Provider Name (Legal Business Name): ZENAIDA ROQUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 MAIN ST
DANSVILLE NY
14437-1111
US

IV. Provider business mailing address

253 MAIN ST
DANSVILLE NY
14437-1111
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-2296
  • Fax: 585-335-2299
Mailing address:
  • Phone: 585-335-2296
  • Fax: 585-335-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number123249
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: