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NPI Code Detail

MEDICARE: DR. JOSE TABARE RODRIGUEZ JR. MD

MEDICARE: DR. JOSE TABARE RODRIGUEZ JR. MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program669-22NY

General Provider Information

NPI Number : 1306772710
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSE TABARE RODRIGUEZ JR. MD
Provider Business Mailing Address
First Line : 1650 GRAND CONCOURSE
Second Line :
City : BRONX
State : NY
Zip : 10457-7679
Country : US
Telephone Number : 718-922-7669
Fax Number :
Provider Business Practice Location Address
First Line : 1650 GRAND CONCOURSE
Second Line :
City : BRONX
State : NY
Zip : 10457-7679
Country : US
Telephone Number : 347-237-2324
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2026
Last Update Date : 06/23/2026

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