MEDICARE: GESSY SARAI RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	101889	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101889	OTHER	NY	MASTER OF SOCIAL WORK LICENSE

General Provider Information

NPI Number	:	1689150559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GESSY SARAI RODRIGUEZ

Provider Business Mailing Address
First Line	:	25 ANNA RD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-1626
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 WASHINGTON AVE STE 2
Second Line	:
City	:	BRENTWOOD
State	:	NY
Zip	:	11717-3247
Country	:	US
Telephone Number	:	631-617-5300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2018
Last Update Date	:	07/13/2018

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