Provider Demographics
NPI:1699038141
Name:RODRIGUEZ, MARILYN
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
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 1:17847 LESLIE RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-2746
Mailing Address - Country:US
Mailing Address - Phone:718-380-7600
Mailing Address - Fax:718-820-9197
Practice Address - Street 1:7102 PARK AVE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-4105
Practice Address - Country:US
Practice Address - Phone:718-380-7600
Practice Address - Fax:718-820-9197
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator