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General NPI Number Information
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NPI Number | 1952054090
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Entity Type | Individual
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Provider Name | RAFAEL BACANI ROQUE NP
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Gender | Male
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Dates
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Enumeration Date | 01/29/2022
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 150 55TH ST
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City | BROOKLYN
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State | NY
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Zip | 11220-2508
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Country | US
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Telephone | 917-679-8317
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Fax |
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Provider Business Mailing Address
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Address Line | 9255 SHORE RD APT 2C
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City | BROOKLYN
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State | NY
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Zip | 11209-6538
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F346423
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License Number State | NY
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