Provider Demographics
NPI:1750400842
Name:RODGERS, STEPHEN L (NP)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:RODGERS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:230 W 17TH ST
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5325
Mailing Address - Country:US
Mailing Address - Phone:212-523-6500
Mailing Address - Fax:212-523-8555
Practice Address - Street 1:230 W 17TH ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5325
Practice Address - Country:US
Practice Address - Phone:212-523-6500
Practice Address - Fax:212-523-8555
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2014-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF330074363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ18191Medicare UPIN