Provider Demographics
NPI:1356419634
Name:RODRIGUEZ, ANGEL LUIS (MD)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:LUIS
Last Name:RODRIGUEZ
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 1:685 WHITE PLAINS ROAD
Mailing Address - Street 2:
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709
Mailing Address - Country:US
Mailing Address - Phone:914-787-4100
Mailing Address - Fax:914-787-4199
Practice Address - Street 1:685 WHITE PLAINS ROAD
Practice Address - Street 2:
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709
Practice Address - Country:US
Practice Address - Phone:914-787-4100
Practice Address - Fax:914-787-4199
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203049207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY78628OtherEMPIRE BLUE CROSS BLUE SH
NY01771122Medicaid
NY786281Medicare PIN
NY78628OtherEMPIRE BLUE CROSS BLUE SH