Healthcare Provider Details

I. General information

NPI: 1073590931
Provider Name (Legal Business Name): WILLIAM RODINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 RICHMOND AVE SUITE 1LL
STATEN ISLAND NY
10314-3937
US

IV. Provider business mailing address

PO BOX 416173
BOSTON MA
02241-6173
US

V. Phone/Fax

Practice location:
  • Phone: 718-370-0307
  • Fax: 718-370-0389
Mailing address:
  • Phone: 610-644-8900
  • Fax: 484-924-0053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number187577
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: