Provider Demographics
NPI:1144380114
Name:RODRIGUEZ-OSPINA, JOSE IGNACIO (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:IGNACIO
Last Name:RODRIGUEZ-OSPINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8722
Mailing Address - Country:US
Mailing Address - Phone:631-665-4392
Mailing Address - Fax:
Practice Address - Street 1:8 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8722
Practice Address - Country:US
Practice Address - Phone:631-665-4392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01181382Medicaid
NY01181382Medicaid
NY50F241Medicare PIN