MEDICARE: ANNY 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	171W00000X	Contractor

General Provider Information

NPI Number	:	1972962058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNY RODRIGUEZ

Provider Business Mailing Address
First Line	:	68 GARDEN ST APT 3A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-4580
Country	:	US
Telephone Number	:	347-885-3581
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 GARDEN ST APT 3A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-4580
Country	:	US
Telephone Number	:	347-885-3581
Fax Number	:

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

Provider Enumeration Date	:	02/17/2016
Last Update Date	:	02/17/2016

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Directions to “ ANNY RODRIGUEZ ” Practice Location

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