Provider Demographics
NPI:1366998312
Name:RODRIGUEZ, ERIDANIA (CERTIFIED TEACHER)
Entity type:Individual
Prefix:MRS
First Name:ERIDANIA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:CERTIFIED TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 E 162ND ST APT 6D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-3375
Mailing Address - Country:US
Mailing Address - Phone:646-242-6238
Mailing Address - Fax:
Practice Address - Street 1:185 E 162ND ST APT 6D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3375
Practice Address - Country:US
Practice Address - Phone:646-242-6238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY951157151174400000X
NY985093151174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist