Provider Demographics
NPI:1063511194
Name:RODRIGUES, LOUIS (MD, MPH, FAAP)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:RODRIGUES
Suffix:
Gender:M
Credentials:MD, MPH, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-4515
Mailing Address - Country:US
Mailing Address - Phone:845-791-6708
Mailing Address - Fax:
Practice Address - Street 1:435 BROADWAY
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1738
Practice Address - Country:US
Practice Address - Phone:845-796-2500
Practice Address - Fax:845-796-2501
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086006208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYSV-0000032OtherSELECT PRO
NY3657OtherWELLCARE
NY328603OtherMVP
NY48685OtherUS HEALTH
NY590262OtherAETNA US
NY903131OtherEMPIRE BC/BS
NYP489084OtherOXFORD
NY00533899Medicaid
NY00609OtherHUDSON HEALTH PLAN
NY141610314R01OtherBLUE CROSS/BLUE SHIELD
NY00533899Medicaid