Provider Demographics
NPI:1154592160
Name:NATALYA RODIONOVA MEDICAL CARE PC
Entity type:Organization
Organization Name:NATALYA RODIONOVA MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:VALERYEVNA
Authorized Official - Last Name:RODIONOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DO
Authorized Official - Phone:718-794-1000
Mailing Address - Street 1:2109 MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2600
Mailing Address - Country:US
Mailing Address - Phone:718-794-1000
Mailing Address - Fax:718-794-5264
Practice Address - Street 1:2109 MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-2600
Practice Address - Country:US
Practice Address - Phone:718-794-1000
Practice Address - Fax:718-794-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218804-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W89171Medicare PIN