Provider Demographics
NPI:1013006592
Name:ROQUE-DIEGUEZ, HILDA ROSA (MD)
Entity type:Individual
Prefix:DR
First Name:HILDA
Middle Name:ROSA
Last Name:ROQUE-DIEGUEZ
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 1:317 60TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5412
Mailing Address - Country:US
Mailing Address - Phone:201-864-0757
Mailing Address - Fax:201-861-3126
Practice Address - Street 1:317 60TH ST
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-5412
Practice Address - Country:US
Practice Address - Phone:201-864-0757
Practice Address - Fax:201-861-3126
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05052300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ673927Medicare PIN
NJE87068Medicare UPIN