Provider Demographics
NPI:1871974212
Name:RODRIGUEZ, ROSA A
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:A
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 1:103 SHAKER CT N
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-8015
Mailing Address - Country:US
Mailing Address - Phone:845-245-4145
Mailing Address - Fax:
Practice Address - Street 1:192 TOWER DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-2056
Practice Address - Country:US
Practice Address - Phone:845-692-4391
Practice Address - Fax:845-692-4397
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator