1114901832 NPI number — DR. DONNA H RODRIGUEZ DC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114901832 NPI number — DR. DONNA H RODRIGUEZ DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
DONNA
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

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:
1114901832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
460 E CHURCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMIRA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14901-2832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-733-3235
Provider Business Mailing Address Fax Number:
607-733-4086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
460 E CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMIRA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14901-2832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-733-3235
Provider Business Practice Location Address Fax Number:
607-733-4086
Provider Enumeration Date:
12/06/2005

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: 111N00000X , with the licence number:  X007615 , 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)

  • Identifier: Y6842 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 350045306 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com