Provider Demographics
NPI:1467894063
Name:RODRIGUEZ, GLENDA E (SPED)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:E
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:SPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 TRINITY AVE
Mailing Address - Street 2:APT 2G
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-3004
Mailing Address - Country:US
Mailing Address - Phone:347-281-3001
Mailing Address - Fax:
Practice Address - Street 1:626 TRINITY AVE
Practice Address - Street 2:APT 2G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3004
Practice Address - Country:US
Practice Address - Phone:347-281-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY468834101174400000X
NY391489101174400000X
NY677803121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist