MEDICARE: CARLOS GREGORIO RODRIGUEZ

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207P00000X	Emergency Medicine Physician	334231	NY

General Provider Information

NPI Number	:	1720738297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS GREGORIO RODRIGUEZ

Provider Business Mailing Address
First Line	:	703 MAIN ST
Second Line	:
City	:	PATERSON
State	:	NJ
Zip	:	07503-2621
Country	:	US
Telephone Number	:	973-754-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 EASTCHESTER RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-2301
Country	:	US
Telephone Number	:	786-470-7326
Fax Number	:

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

Provider Enumeration Date	:	03/26/2022
Last Update Date	:	02/04/2026

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Directions to “ CARLOS GREGORIO RODRIGUEZ ” Practice Location

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