Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 021726 | NY |
NPI | 1306353255 |
---|---|
Provider Name | Anthony Rodriguez |
First Address | West Chicago, IL 60185-5208 |
Second Address | New York, NY 10003-3851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2018 |
Last Update Date | 01/01/2018 |