Healthcare Provider Details

I. General information

NPI: 1700809522
Provider Name (Legal Business Name): LINDA RODMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 30TH AVE
LONG ISLAND CITY NY
11102-2448
US

IV. Provider business mailing address

333 E 80TH ST #1C
NEW YORK NY
10021-0659
US

V. Phone/Fax

Practice location:
  • Phone: 718-267-4245
  • Fax:
Mailing address:
  • Phone: 212-535-5159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number302518
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: