Provider Demographics
NPI:1992030662
Name:CARMEN J RODRIGUEZ, MD PC
Entity Type:Organization
Organization Name:CARMEN J RODRIGUEZ, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CAMEN
Authorized Official - Middle Name:JULIA
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-365-2100
Mailing Address - Street 1:800 COMMUNITY DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3822
Mailing Address - Country:US
Mailing Address - Phone:516-365-2100
Mailing Address - Fax:516-365-2124
Practice Address - Street 1:800 COMMUNITY DR
Practice Address - Street 2:SUITE 215
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3822
Practice Address - Country:US
Practice Address - Phone:516-365-2100
Practice Address - Fax:516-365-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195330305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100045789Medicare PIN