Healthcare Provider Details

I. General information

NPI: 1336724970
Provider Name (Legal Business Name): ERIBEL RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 KIMBALL ST STE 202
BROOKLYN NY
11234-5159
US

IV. Provider business mailing address

2270 KIMBALL ST STE 202
BROOKLYN NY
11234-5159
US

V. Phone/Fax

Practice location:
  • Phone: 718-253-0888
  • Fax:
Mailing address:
  • Phone: 718-253-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number062715
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: