Provider Demographics
NPI:1427214089
Name:MARIGOMEN, ROGER ROCA (PT)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:ROCA
Last Name:MARIGOMEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 E 149TH ST FL 9
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-3906
Mailing Address - Country:US
Mailing Address - Phone:718-401-1111
Mailing Address - Fax:718-401-2723
Practice Address - Street 1:369 E 149TH ST FL 9
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3906
Practice Address - Country:US
Practice Address - Phone:718-401-1111
Practice Address - Fax:718-401-2723
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020098-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist