Healthcare Provider Details

I. General information

NPI: 1811921349
Provider Name (Legal Business Name): LUIS RAMON RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY, WOODHULL MEDICAL & MENTAL HEALTH CENTER DEPARTMENT OF PEDIATRICS
BROOKLYN NY
11206
US

IV. Provider business mailing address

760 BROADWAY, WOODHULL MEDICAL & MENTAL HEALTH CENTER DEPARTMENT OF PEDIATRICS ROOM 2B-321
BROOKLYN NY
11206
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-8000
  • Fax: 718-630-3122
Mailing address:
  • Phone: 718-963-8000
  • Fax: 718-630-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number177629
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number177629
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: