Provider Demographics
NPI:1922578517
Name:RODRIGUEZ, NADIA N (CASE MANAGER)
Entity Type:Individual
Prefix:MS
First Name:NADIA
Middle Name:N
Last Name:RODRIGUEZ
Suffix:
Gender:F
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 1:2511 WESTCHESTER AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461
Mailing Address - Country:US
Mailing Address - Phone:347-575-0936
Mailing Address - Fax:516-621-1259
Practice Address - Street 1:2511 WESTCHESTER AVE APT 202
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3580
Practice Address - Country:US
Practice Address - Phone:347-575-0936
Practice Address - Fax:516-621-1259
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY312909176Medicaid