1164515649 NPI number — DR. FELIX JUAN RODRIGUEZ DDS

Table of content: DR. FELIX JUAN RODRIGUEZ DDS (NPI 1164515649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164515649 NPI number — DR. FELIX JUAN RODRIGUEZ DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUEZ
Provider First Name:
FELIX
Provider Middle Name:
JUAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
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:
1164515649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2951 GRAND CONCOURSE
Provider Second Line Business Mailing Address:
SUITE NUMBER 6
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-561-0773
Provider Business Mailing Address Fax Number:
718-561-4714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2951 GRAND CONCOURSE
Provider Second Line Business Practice Location Address:
SUITE NUMBER 6
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-561-0773
Provider Business Practice Location Address Fax Number:
718-561-4714
Provider Enumeration Date:
10/02/2006

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: 1223G0001X , with the licence number:  046173 , 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: 01602313 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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