Active NPI
Mark R Rodman, ATC
- Athletic Trainer
- Oakdale, NY
National Provider Identifier
1073541504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 000828-1
- Practice address
- 150 Idle Hour Blvd
Oakdale, NY 11769-1906 - Phone
- (631) 244-1119
- NPI assigned
- Jun 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 000828-1 | NY | Primary |
Addresses
Primary practice location
150 Idle Hour Blvd
Oakdale, NY 11769-1906
Mailing address
12 Winmar LN
Sayville, NY 11782-1371
Phone (516) 805-5203
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000828-1 | NY | MD | Psychoanalyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073541504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12 WINMAR LN",
"city": "SAYVILLE",
"state": "NY",
"postal_code": "117821371",
"telephone_number": "516-805-5203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 IDLE HOUR BLVD",
"city": "OAKDALE",
"state": "NY",
"postal_code": "117691906",
"telephone_number": "631-244-1119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODMAN",
"first_name": "MARK",
"middle_name": "R",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NY",
"license": "000828-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakdale, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.