Healthcare Provider Details

I. General information

NPI: 1023654217
Provider Name (Legal Business Name): OSCAR ANDRES RODRIGUEZ-AYALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date: 05/30/2024
Reactivation Date: 07/03/2024

III. Provider practice location address

5316 NESCONSET HWY
PORT JEFFERSON STATION NY
11776-2591
US

IV. Provider business mailing address

1 RESEARCH RD
RIDGE NY
11961-2701
US

V. Phone/Fax

Practice location:
  • Phone: 631-751-3000
  • Fax:
Mailing address:
  • Phone: 631-751-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number346116
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: