Jacqueline Mary Roulette

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

020674 Issued in NY

Practice address

8 Laurel Ave
East Islip, NY 11730-2190

Phone

(631) 224-4442

NPI assigned

Mar 9, 2017

Last updated

Mar 9, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1489017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489017600000",
    "number": "1346781457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 LAUREL AVE",
            "city": "EAST ISLIP",
            "state": "NY",
            "postal_code": "117302190",
            "telephone_number": "631-224-4442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 LAUREL AVE",
            "city": "EAST ISLIP",
            "state": "NY",
            "postal_code": "117302190",
            "telephone_number": "631-224-4442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROULETTE",
        "first_name": "JACQUELINE",
        "middle_name": "MARY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-09",
        "last_updated": "2017-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "020674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis M Rosand, M.S.
• Gary Alan Rosenfeld, DDS
• Andrea Ross, M.S., BCBA
• Neil Rothkopf, DDS
• Deborah Rotunno, CD(DONA), CPD(CAPPA)
• Renee Beth Ruggiero, LAC
• Robert F Ruggiero
• Rosa Ruvio, LMHC, M.S.
• Carol A Ryan-Behr
• Jennifer Sue Sambo

• Physician Assistant in East Islip, NY
• Providers in East Islip, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.