Provider Demographics
NPI:1235847278
Name:RODRIGUEZ, ROMAN COLON
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:COLON
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 CROTONA AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-2787
Mailing Address - Country:US
Mailing Address - Phone:347-364-6632
Mailing Address - Fax:
Practice Address - Street 1:463 7TH AVE # 18TH
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7604
Practice Address - Country:US
Practice Address - Phone:212-582-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst