1700013497 NPI number — MR. MAXIMO TIUKINHOY RODRIGUEZ III RPT

Table of content: MR. MAXIMO TIUKINHOY RODRIGUEZ III RPT (NPI 1700013497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700013497 NPI number — MR. MAXIMO TIUKINHOY RODRIGUEZ III RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
MAXIMO
Provider Middle Name:
TIUKINHOY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
III
Provider Credential Text:
RPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700013497
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
98-76 QUEENS BOULEVARD
Provider Second Line Business Mailing Address:
SUITE 1K
Provider Business Mailing Address City Name:
REGO PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-897-0300
Provider Business Mailing Address Fax Number:
718-897-3330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
98-76 QUEENS BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 1K
Provider Business Practice Location Address City Name:
REGO PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-897-0300
Provider Business Practice Location Address Fax Number:
718-897-3330
Provider Enumeration Date:
06/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  029336 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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