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General NPI Number Information
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NPI Number | 1275617987
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Entity Type | Individual
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Provider Name | PEDRO J ROQUE MD
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 600 SUFFOLK AVE STE B
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City | BRENTWOOD
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State | NY
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Zip | 11717-4311
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Country | US
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Telephone | 631-435-2133
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Fax | 631-435-4365
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Provider Business Mailing Address
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Address Line | 1010 NORTHERN BLVD STE 328
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City | GREAT NECK
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State | NY
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Zip | 11021-5329
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Country | US
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Telephone | 516-233-2484
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Fax | 516-304-5850
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 157218
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License Number State | NY
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