=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649570995
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSE I RODRIGUEZ-OSPINA MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2010
-----------------------------------------------------
Last Update Date | 12/23/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9319 ROOSEVELT AVE
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-7943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-205-4900
-----------------------------------------------------
Fax | 718-205-4909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9319 ROOSEVELT AVE
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-7943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-205-4900
-----------------------------------------------------
Fax | 718-205-4909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/M.D.
-----------------------------------------------------
Name | MR. JOSE IGNACIO RODRIGUEZ-OSPINA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 718-205-4900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------