| Doctor Name: | DR. JOSE RAMON ROQUE |
| NPI Number: | 1134254162 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD, BCNS, CNC |
| License Number: | 3002 |
| Business Practice Address: | 1111 22nd St North Bergen, NJ - 070472003 |
| Business Phone Number: | 2018668121 |
| Business Fax Number: | 2018668004 |
| Mailing Address: | 1111-22 Street, NORTH BERGEN |
| State: | NJ |
| Postal Code: | 07047 |
| Phone Number: | 2018668121 |
| Fax Number: | 2018668004 |
| NPI Enumeration Date: | 02/22/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133NN1002X |
| License Number: | 3002 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Nutritionist |
| Taxonomy Specialization: | Nutrition, Education |
| Taxonomy Definition: | |