Healthcare Provider Details

I. General information

NPI: 1861706152
Provider Name (Legal Business Name): NORMA TABILE ROQUE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 07/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W 32ND ST 8TH FLOOR
NEW YORK NY
10001-3212
US

IV. Provider business mailing address

401 1ST AVE APT 22D
NEW YORK NY
10010-4005
US

V. Phone/Fax

Practice location:
  • Phone: 212-564-2350
  • Fax:
Mailing address:
  • Phone: 212-889-8754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number235904-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: