Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 048148 | NY |
Y | 213EG0000X | General Practice | 048148 | NY |
NPI | 1003032608 |
---|---|
Provider Name | Dr. Jacqueline B Rodgers |
First Address | Huntington, NY 11743-3975 |
Second Address | Huntington, NY 11743-3975 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 08/07/2007 |