1770021743 NPI number — GEORGE L. RODRIGUEZ, M.D., PC

Table of content: (NPI 1770021743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770021743 NPI number — GEORGE L. RODRIGUEZ, M.D., PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGE L. RODRIGUEZ, M.D., PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ADVANCED DIAGNOSTICS
Provider Other Organization Name Type Code:
3
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:
1770021743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 E CITY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALA CYNWYD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19004-1708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
841 E ALLEGHENY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19134-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-425-1500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZILBER
Authorized Official First Name:
SIDNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL COUNSEL
Authorized Official Telephone Number:
215-473-1500

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , with the licence number:  MD036647E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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