Provider Demographics
NPI:1891865986
Name:RODRIGUEZ, EDUARDO GO (PT)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:GO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8592 148TH ST
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2832
Mailing Address - Country:US
Mailing Address - Phone:718-854-9055
Mailing Address - Fax:718-854-9121
Practice Address - Street 1:110 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2457
Practice Address - Country:US
Practice Address - Phone:718-854-9055
Practice Address - Fax:718-854-9121
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0134521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist