Healthcare Provider Details

I. General information

NPI: 1891774477
Provider Name (Legal Business Name): ALEXANDER GERALD M RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY WOODHULL HOSPITAL
BROOKLYN NY
11206-5317
US

IV. Provider business mailing address

371 1ST AVE APT. 4B
NEW YORK NY
10010-6504
US

V. Phone/Fax

Practice location:
  • Phone: 718-260-7503
  • Fax:
Mailing address:
  • Phone: 917-858-9481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number275016
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: