MEDICARE: DR. EMMANUEL N RODRIGUEZ 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
1	207R00000X	Internal Medicine Physician	250792	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497856728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMMANUEL N RODRIGUEZ MD

Provider Business Mailing Address
First Line	:	325 E 64TH ST APT 309
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-6770
Country	:	US
Telephone Number	:	347-573-1019
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 E 83RD ST
Second Line	:	4D
City	:	NEW YORK
State	:	NY
Zip	:	10028-2403
Country	:	US
Telephone Number	:	646-416-0744
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	03/28/2023

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