Provider Demographics
NPI:1710508866
Name:RODRIGUES, ALEXANDER SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:SCOTT
Last Name:RODRIGUES
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 1:15 COUNTRY SQUIRE CT
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1735
Mailing Address - Country:US
Mailing Address - Phone:646-831-1461
Mailing Address - Fax:
Practice Address - Street 1:15 COUNTRY SQUIRE CT
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1735
Practice Address - Country:US
Practice Address - Phone:646-831-1461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY325219207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program