Provider Demographics
NPI:1114677184
Name:MAGNO, ROCHELLE R ENRIQUEZ
Entity Type:Individual
Prefix:
First Name:ROCHELLE R
Middle Name:ENRIQUEZ
Last Name:MAGNO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 ERIE STREET
Mailing Address - Street 2:STORE FRONT
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302
Mailing Address - Country:US
Mailing Address - Phone:657-229-5274
Mailing Address - Fax:
Practice Address - Street 1:89 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2212
Practice Address - Country:US
Practice Address - Phone:657-229-5274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist