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NPI Code Detail

MEDICARE: DR. DAVID A RODRIGUEZ PH.D.

MEDICARE: DR. DAVID A RODRIGUEZ PH.D.
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
1103TC0700XClinical Psychologist021988NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11285628552OTHERNYAGENCY NPI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538221569
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID A RODRIGUEZ PH.D.
Provider Business Mailing Address
First Line : 28 FOREST LN
Second Line :
City : BREWSTER
State : NY
Zip : 10509-3014
Country : US
Telephone Number : 845-278-6591
Fax Number :
Provider Business Practice Location Address
First Line : 3512 QUENTIN RD STE 110
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-4245
Country : US
Telephone Number : 800-275-3243
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2006
Last Update Date : 11/16/2021

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