Provider Demographics
NPI:1235158577
Name:RODRIGUEZ II, ROBERTO (NP)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:
Last Name:RODRIGUEZ II
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STONYBROOK HOSPITAL HSC LEVEL 18 RM 0-40
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0001
Mailing Address - Country:US
Mailing Address - Phone:631-444-1045
Mailing Address - Fax:631-444-6176
Practice Address - Street 1:STONYBROOK HOSPITAL HSC LEVEL 18 RM 0-40
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0001
Practice Address - Country:US
Practice Address - Phone:631-444-1045
Practice Address - Fax:631-444-6176
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332366363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02591179Medicaid
NYS92789Medicare UPIN
NY02591179Medicaid