Active NPI
Alexandra Roque, ATC
- Athletic Trainer
- Freehold, NJ
National Provider Identifier
1104536663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 25MT00334400
- Practice address
- 210 Mounts Corner Dr
Freehold, NJ 07728-2547 - Phone
- (732) 538-8561
- NPI assigned
- Nov 24, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 25MT00334400 | NJ | Primary |
Addresses
Primary practice location
210 Mounts Corner Dr
Freehold, NJ 07728-2547
Mailing address
1455 Broad St Ste 250
Bloomfield, NJ 07003-3066
Phone (877) 532-7837
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MT00334400 | NJ | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669248000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1741824000000",
"number": "1104536663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1455 BROAD ST STE 250",
"city": "BLOOMFIELD",
"state": "NJ",
"postal_code": "070033066",
"telephone_number": "877-532-7837"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 MOUNTS CORNER DR",
"city": "FREEHOLD",
"state": "NJ",
"postal_code": "077282547",
"telephone_number": "732-538-8561"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROQUE",
"first_name": "ALEXANDRA",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-11-24",
"last_updated": "2025-03-13",
"certification_date": "2025-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NJ",
"license": "25MT00334400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Freehold, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.