Provider Demographics
NPI:1770272189
Name:RODRIGUEZ, TABITHA ANN
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:ANN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 MADISON AVE APT 17A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-1818
Mailing Address - Country:US
Mailing Address - Phone:646-856-1822
Mailing Address - Fax:
Practice Address - Street 1:25 CHAPEL ST STE 905
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1916
Practice Address - Country:US
Practice Address - Phone:718-846-9875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator