Provider Demographics
NPI:1811201288
Name:RODRIGUEZ, MARTHA ELIZABETH (ANP)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:ELIZABETH
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 EAST 66TH STREET
Mailing Address - Street 2:EVELYN LAUDER BREAST CENTER AND MSKCC IMAGING CENTER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 EAST 66TH STREET
Practice Address - Street 2:EVELYN LAUDER BREAST CENTER AND MSKCC IMAGING CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:646-888-5481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301356-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health