Provider Demographics
NPI:1083112874
Name:DODOO, RODERICK (RRT, RPSGT)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:
Last Name:DODOO
Suffix:
Gender:M
Credentials:RRT, RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 SYCAMORE AVENUE
Mailing Address - Street 2:SUITE #45 SECOND FLOOR
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716
Mailing Address - Country:US
Mailing Address - Phone:637-385-3185
Mailing Address - Fax:631-337-6019
Practice Address - Street 1:2280 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2911
Practice Address - Country:US
Practice Address - Phone:347-385-3185
Practice Address - Fax:631-337-6019
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0081022279P1004X, 2279G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care
No2279P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Diagnostics