Provider Demographics
NPI:1548378292
Name:CHAPMAN RODRIGUEZ, ROSE (ETC NP)
Entity type:Individual
Prefix:MS
First Name:ROSE
Middle Name:
Last Name:CHAPMAN RODRIGUEZ
Suffix:
Gender:F
Credentials:ETC NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3959 BROADWAY
Mailing Address - Street 2:COLUMBIA UNIVERSITY DEPARTMENT PEDIATRICS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1559
Mailing Address - Country:US
Mailing Address - Phone:212-304-7250
Mailing Address - Fax:212-544-1974
Practice Address - Street 1:3959 BROADWAY
Practice Address - Street 2:COLUMBIA UNIVERSITY DEPARTMENT PEDIATRICS
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:212-304-7250
Practice Address - Fax:212-544-1974
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381795363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02801696Medicaid