1992891915 NPI number — DR. JOLIE RENE RODRIGUEZ M.D.

Table of content: DR. JOLIE RENE RODRIGUEZ M.D. (NPI 1992891915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992891915 NPI number — DR. JOLIE RENE RODRIGUEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
JOLIE
Provider Middle Name:
RENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1992891915
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2233 STATE ROUTE 86
Provider Second Line Business Mailing Address:
ADIRONDACK MEDICAL CENTER - DEPT. OF PATHOLOGY
Provider Business Mailing Address City Name:
SARANAC LAKE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12983-5644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-897-2364
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2233 STATE ROUTE 86
Provider Second Line Business Practice Location Address:
ADIRONDACK MEDICAL CENTER - DEPT. OF PATHOLOGY
Provider Business Practice Location Address City Name:
SARANAC LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12983-5644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-897-2364
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2006

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: 207ZP0102X , with the licence number:  00027256 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ZP0102X , with the licence number: 255449 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZF0201X , with the licence number: 255449 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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