Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 019359 | NY |
N | 225100000X | Physical Therapist | 40QA00800700 | NJ |
Y | 2251H1200X | Hand | 40QA00800700 | NJ |
N | 2251X0800X | Physical Therapist - Orthopedic | 40QA00800700 | NJ |
NPI | 1811051865 |
---|---|
Provider Name | Norman A Roque |
First Address | Englewood, NJ 07631-4600 |
Second Address | Englewood, NJ 07631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 17/05/2018 |