Provider Demographics
NPI:1215265707
Name:RODRIGUEZ-ELIZALDE, SEBASTIAN R (MD, FRCPC)
Entity type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:R
Last Name:RODRIGUEZ-ELIZALDE
Suffix:
Gender:M
Credentials:MD, FRCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 E 63RD ST
Mailing Address - Street 2:APARTMENT 9J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7918
Mailing Address - Country:US
Mailing Address - Phone:917-828-3482
Mailing Address - Fax:
Practice Address - Street 1:430 E 63RD ST
Practice Address - Street 2:APARTMENT 9J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7918
Practice Address - Country:US
Practice Address - Phone:917-828-3482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital