Provider Demographics
NPI:1780195578
Name:RODRIGUEZ, JAIME A (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17305 107TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-2534
Mailing Address - Country:US
Mailing Address - Phone:347-235-2900
Mailing Address - Fax:
Practice Address - Street 1:61 BRADFORD ST APT 3L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-2501
Practice Address - Country:US
Practice Address - Phone:347-235-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator