Healthcare Provider Details

I. General information

NPI: 1376541987
Provider Name (Legal Business Name): MARTIN MANUEL RODRIGUEZ-EMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NETHERLAND AVE SUITE 120
BRONX NY
10463-4801
US

IV. Provider business mailing address

2600 NETHERLAND AVE SUITE 120
BRONX NY
10463-4801
US

V. Phone/Fax

Practice location:
  • Phone: 718-796-3580
  • Fax: 718-796-3987
Mailing address:
  • Phone: 718-796-3580
  • Fax: 718-796-3987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number177483
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: