Provider Demographics
NPI:1023167459
Name:RODRIGUEZ, EZEQUIEL JOSUE (RPA-C)
Entity type:Individual
Prefix:MR
First Name:EZEQUIEL
Middle Name:JOSUE
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:RPA-C
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Other - First Name:
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Mailing Address - Street 1:200 WINSTON DR
Mailing Address - Street 2:APT. B15
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 AMSTERDAM AVE
Practice Address - Street 2:ORTHO DEPT. CLARK 7
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1716
Practice Address - Country:US
Practice Address - Phone:212-523-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY011475-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant