Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 309528 | NY |
NPI | 1023641594 |
---|---|
Provider Name | Moses Joel Rodriguez |
First Address | New York, NY 10019-8022 |
Second Address | New York, NY 10019-8022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2020 |
Last Update Date | 01/12/2021 |