NPI Code Detail JSON Logo

1275617987 NPI number — PEDRO J ROQUE MD

NPI Number: 1275617987
Health Care Provider/Practitioner: PEDRO J ROQUE MD

Information about “1275617987” NPI (PEDRO J ROQUE MD) exists in 1275617987 in HTML format HTML  |  1275617987 in plain Text format TXT  |  1275617987 in PDF (Portable Document Format) PDF  |  1275617987 in an XML format XML  formats.

NPI Number : 1275617987 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275617987",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ROQUE",
    "FirstName": "PEDRO",
    "MiddleName": "J",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ROQUE-RODRIGUEZ",
    "OtherFirstName": "PEDRO",
    "OtherMiddleName": "J",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "1010 NORTHERN BLVD STE 328",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GREAT NECK",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11021-5329",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "516-233-2484",
    "MailingAddressFaxNumber": "516-304-5850",
    "FirstLinePracticeLocationAddress": "600 SUFFOLK AVE STE B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BRENTWOOD",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11717-4311",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "631-435-2133",
    "PracticeLocationAddressFaxNumber": "631-435-4365",
    "EnumerationDate": "10/25/2006",
    "LastUpdateDate": "11/21/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207R00000X",
        "TaxonomyName": "Internal Medicine Physician",
        "LicenseNumber": "157218",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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