Provider Demographics
NPI:1144298175
Name:RODRIGUEZ, RAFAEL (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001A ROOSEVELT AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7426
Mailing Address - Country:US
Mailing Address - Phone:718-505-0030
Mailing Address - Fax:718-505-0032
Practice Address - Street 1:9001A ROOSEVELT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7426
Practice Address - Country:US
Practice Address - Phone:718-505-0030
Practice Address - Fax:718-505-0032
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228907207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02461109Medicaid
NYH98234Medicare UPIN
NY06024Medicare ID - Type Unspecified