Provider Demographics
NPI:1619033677
Name:RODRIGUEZ, DENNY XAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNY
Middle Name:XAVIER
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5901
Mailing Address - Country:US
Mailing Address - Phone:201-313-6867
Mailing Address - Fax:973-779-3854
Practice Address - Street 1:170 W 233RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5639
Practice Address - Country:US
Practice Address - Phone:718-543-0700
Practice Address - Fax:718-543-0788
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02897712Medicaid
NY5258PAW511Medicare PIN
NY02897712Medicaid