Provider Demographics
NPI:1215207287
Name:RODRIGUEZ, GILBERT ANTONIO (DC)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:ANTONIO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 COLIGNI AVE APT 3B
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-2635
Mailing Address - Country:US
Mailing Address - Phone:917-439-3443
Mailing Address - Fax:
Practice Address - Street 1:20 SQUADRON BLVD STE 580
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5272
Practice Address - Country:US
Practice Address - Phone:888-634-8807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor