Provider Demographics
NPI:1225177371
Name:RODRIGUEZ, RHINA (M D)
Entity Type:Individual
Prefix:
First Name:RHINA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 S BAY AVE
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-4214
Mailing Address - Country:US
Mailing Address - Phone:631-598-3486
Mailing Address - Fax:
Practice Address - Street 1:9014 ELMHURST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7936
Practice Address - Country:US
Practice Address - Phone:718-899-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152680208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00965857Medicaid