Provider Demographics
NPI:1679654768
Name:RODIONOVA, NATALYA (MD, DO)
Entity Type:Individual
Prefix:DR
First Name:NATALYA
Middle Name:
Last Name:RODIONOVA
Suffix:
Gender:F
Credentials:MD, DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2600
Mailing Address - Country:US
Mailing Address - Phone:718-794-1000
Mailing Address - Fax:718-794-5264
Practice Address - Street 1:2109 MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-2600
Practice Address - Country:US
Practice Address - Phone:718-794-1000
Practice Address - Fax:718-794-5264
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02215492Medicaid
NY5D9441Medicare PIN
NYH56255Medicare UPIN