Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 040949 | NY |
NPI | 1023582913 |
---|---|
Provider Name | Andrew Roderick |
First Address | Syracuse, NY 13210-2306 |
Second Address | Syracuse, NY 13210-2306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2019 |
Last Update Date | 14/01/2019 |