Provider Demographics
NPI:1215332119
Name:RODRIGUEZ, GAY PERCOLIZA GATDULA (NP-C)
Entity type:Individual
Prefix:
First Name:GAY
Middle Name:PERCOLIZA GATDULA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-2206
Mailing Address - Country:US
Mailing Address - Phone:201-887-2197
Mailing Address - Fax:
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-5194
Practice Address - Fax:212-746-7868
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307137363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health