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General NPI Number Information
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NPI Number | 1518663913
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Entity Type | Individual
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Provider Name | MYRENE ANGELINE ROQUE
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Gender | Female
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Dates
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Enumeration Date | 02/07/2023
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Last Update Date | 02/07/2023
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Provider Practice Location Address
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Address Line | 1500 WATERS PL
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City | BRONX
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State | NY
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Zip | 10461-2723
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Country | US
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Telephone | 929-348-3464
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Fax |
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Provider Business Mailing Address
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Address Line | 1542 MAC DONOUGH PL
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City | BRONX
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State | NY
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Zip | 10465-1130
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Country | US
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Telephone | 646-409-7673
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Fax |
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 785234
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License Number State | NY
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