Provider Demographics
NPI:1497856728
Name:RODRIGUEZ, EMMANUEL N (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:N
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E 64TH ST APT 309
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6770
Mailing Address - Country:US
Mailing Address - Phone:347-573-1019
Mailing Address - Fax:
Practice Address - Street 1:165 E 83RD ST
Practice Address - Street 2:4D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2403
Practice Address - Country:US
Practice Address - Phone:646-416-0744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250792207R00000X
WI46425-020207RI0200X, 208M00000X
COCDR0000191208M00000X
MA238423207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34529800Medicaid
WI34529800Medicaid