Provider Demographics
NPI:1093058356
Name:ROQUE, ASHLEY (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:ROQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E 42ND ST # 910
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5806
Mailing Address - Country:US
Mailing Address - Phone:347-920-7015
Mailing Address - Fax:
Practice Address - Street 1:3030 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-2809
Practice Address - Country:US
Practice Address - Phone:212-609-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2980602084H0002X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084H0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyHospice and Palliative Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program