Provider Demographics
NPI:1881654143
Name:RODRIGUEZ, CONSUELO (MD)
Entity Type:Individual
Prefix:
First Name:CONSUELO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
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:PO BOX 176H
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-8676
Mailing Address - Country:US
Mailing Address - Phone:914-633-9450
Mailing Address - Fax:
Practice Address - Street 1:2365 BOSTON POST RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3500
Practice Address - Country:US
Practice Address - Phone:914-633-9450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196990207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01504627Medicaid
NYF98721Medicare UPIN
NY37J851Medicare ID - Type Unspecified