Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 241813 | NY |
NPI | 1396837522 |
---|---|
Provider Name | Juan Carlos Rodriguez |
First Address | New York, NY 10003-3605 |
Second Address | New York, NY 10003-3605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 26/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02814042 | (05) | NY |
I63660 | (02) |