Provider Demographics
NPI:1811921349
Name:RODRIGUEZ, LUIS RAMON (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:RAMON
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:760 BROADWAY, WOODHULL MEDICAL & MENTAL HEALTH CENTER
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS ROOM 2B-321
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206
Mailing Address - Country:US
Mailing Address - Phone:718-963-8000
Mailing Address - Fax:718-630-3122
Practice Address - Street 1:760 BROADWAY, WOODHULL MEDICAL & MENTAL HEALTH CENTER
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-963-8000
Practice Address - Fax:718-630-3122
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-03-28
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Provider Licenses
StateLicense IDTaxonomies
NY177629208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01358387Medicaid
NY5330RL / 0026RHMedicare ID - Type Unspecified
NY01358387Medicaid