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General NPI Number Information
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NPI Number | 1134254162
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Entity Type | Individual
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Provider Name | JOSE RAMON ROQUE JR. MD, BCNS, CNC
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Gender | Male
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1111 22ND ST
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City | NORTH BERGEN
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State | NJ
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Zip | 07047-2003
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Country | US
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Telephone | 201-866-8121
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Fax | 201-866-8004
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Provider Business Mailing Address
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Address Line | 1111-22 STREET
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City | NORTH BERGEN
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State | NJ
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Zip | 07047
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Country | US
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Telephone | 201-866-8121
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Fax | 201-866-8004
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 3002
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License Number State | NJ
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