Individual
DR. CLEMENTE T ROQUE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
UNIVERSITY HOSPITAL, STONY BROOK, NY 11794-0001
(631) 444-6919
Mailing address
PO BOX 1559, STONY BROOK, NY 11790-0989
(631) 444-6919
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
Primary
158433
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00840304
—
NY
01
—
23D55
EMPIRE BC.BS
NY
01
—
4314845
AETNA
NY
Enumeration date
06/15/2006
Last updated
07/21/2022
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