MEDICARE: ASHLEY ROQUE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084H0002X	Hospice and Palliative Medicine (Psychiatry & Neurology) Physician	298060	NY
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1093058356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY ROQUE MD

Provider Business Mailing Address
First Line	:	220 E 42ND ST # 910
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-5806
Country	:	US
Telephone Number	:	347-920-7015
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 NORTHERN BLVD
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-2809
Country	:	US
Telephone Number	:	212-609-1920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2013
Last Update Date	:	02/01/2024

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