Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 036134910 | IL |
Y | 207T00000X | Neurosurgeon | 257509 | NY |
NPI | 1003012568 |
---|---|
Provider Name | Dr. Shaun David Rodgers |
First Address | New Hyde Park, NY 11042-1101 |
Second Address | New Hyde Park, NY 11042-1101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 09/09/2015 |