MEDICARE: ROD DAVID DUQUE

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	224Y00000X	Clinical Exercise Physiologist
2	225100000X	Physical Therapist	051470	NY

General Provider Information

NPI Number	:	1982499117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROD DAVID DUQUE

Provider Business Mailing Address
First Line	:	92 WADSWORTH AVE APT 4A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10033-7022
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1534 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-4249
Country	:	US
Telephone Number	:	718-576-6266
Fax Number	:

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

Provider Enumeration Date	:	04/09/2025
Last Update Date	:	08/14/2025

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Directions to “ ROD DAVID DUQUE ” Practice Location

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