Provider Demographics
NPI:1417170366
Name:ROQUE, CELIA GARCIA (MD)
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:GARCIA
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 1:2 SENECA RD
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-1524
Mailing Address - Country:US
Mailing Address - Phone:908-276-8538
Mailing Address - Fax:908-276-2331
Practice Address - Street 1:2 SENECA RD
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-1524
Practice Address - Country:US
Practice Address - Phone:908-276-8538
Practice Address - Fax:908-276-2331
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02401100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJB17823Medicare UPIN