Provider Demographics
NPI:1487200051
Name:DUCKETT, ROGER
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:
Last Name:DUCKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 HARDING HWY
Mailing Address - Street 2:
Mailing Address - City:BUENA
Mailing Address - State:NJ
Mailing Address - Zip Code:08310-1533
Mailing Address - Country:US
Mailing Address - Phone:215-756-7349
Mailing Address - Fax:
Practice Address - Street 1:1035 HARDING HWY
Practice Address - Street 2:
Practice Address - City:BUENA
Practice Address - State:NJ
Practice Address - Zip Code:08310-1533
Practice Address - Country:US
Practice Address - Phone:215-756-7349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-10
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist