Provider Demographics
NPI:1437562857
Name:RODRIGUEZ, JENNIFER
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 SPRINGMEADOW DR
Mailing Address - Street 2:UNIT E.
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4133
Mailing Address - Country:US
Mailing Address - Phone:516-236-8040
Mailing Address - Fax:
Practice Address - Street 1:228 SPRINGMEADOW DR
Practice Address - Street 2:UNIT E.
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4133
Practice Address - Country:US
Practice Address - Phone:516-236-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist