Provider Demographics
NPI:1003839598
Name:UY, RODOLFO COMUYOG (MD)
Entity type:Individual
Prefix:MR
First Name:RODOLFO
Middle Name:COMUYOG
Last Name:UY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 NEREID AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1201
Mailing Address - Country:US
Mailing Address - Phone:718-994-6755
Mailing Address - Fax:718-994-3032
Practice Address - Street 1:711 NEREID AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1201
Practice Address - Country:US
Practice Address - Phone:718-994-6755
Practice Address - Fax:718-994-3032
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166745208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00968790Medicaid
NY166745OtherLICENSE
NYRU0500Z510Medicare PIN
NY166745OtherLICENSE
NY00968790Medicaid