Provider Demographics
NPI:1568576023
Name:ROQUE, YVONNE AMANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:AMANDA
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:P.O. BOX 5450
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-5450
Mailing Address - Country:US
Mailing Address - Phone:718-246-8590
Mailing Address - Fax:718-246-8656
Practice Address - Street 1:506 6 STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-246-8590
Practice Address - Fax:718-246-8656
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA877192084P0800X
NY2511432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03110698Medicaid
DEI24061Medicare UPIN
NY03110698Medicaid