Provider Demographics
NPI:1487957908
Name:RODRIGUEZ, FRED (RN)
Entity type:Individual
Prefix:MR
First Name:FRED
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BEVERLY RD
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-3410
Mailing Address - Country:US
Mailing Address - Phone:516-659-4362
Mailing Address - Fax:
Practice Address - Street 1:23 BEVERLY RD
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-3410
Practice Address - Country:US
Practice Address - Phone:516-659-4362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY478181163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse