Provider Demographics
NPI:1336467711
Name:GAE RODKE MD FACOG PLLC
Entity Type:Organization
Organization Name:GAE RODKE MD FACOG PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GAE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-496-9800
Mailing Address - Street 1:185 WEST END AVE
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5540
Mailing Address - Country:US
Mailing Address - Phone:212-496-9800
Mailing Address - Fax:212-496-9891
Practice Address - Street 1:185 WEST END AVE
Practice Address - Street 2:SUITE 1D
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10023-5540
Practice Address - Country:US
Practice Address - Phone:212-496-9800
Practice Address - Fax:212-496-9891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154249-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty