Provider Demographics
NPI:1295761435
Name:RODRIGUEZ-GOODEMOTE, RENEE (MD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:RODRIGUEZ-GOODEMOTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-4226
Mailing Address - Country:US
Mailing Address - Phone:518-886-5600
Mailing Address - Fax:518-886-5805
Practice Address - Street 1:24 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-4226
Practice Address - Country:US
Practice Address - Phone:518-886-5600
Practice Address - Fax:518-886-5805
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02304956Medicaid
NY02304956Medicaid
NYRA5478Medicare ID - Type Unspecified