Active NPI
Evelyn Rodriguez
- Specialist
- Queens, NY
National Provider Identifier
1619746104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 16791432
- Practice address
- 61- 43 186TH Street Fresh Meadows,
Queens, NY 11365 - Phone
- (929) 200-7105
- NPI assigned
- Dec 26, 2023
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 16791432 | NY | Primary |
Addresses
Primary practice location
61- 43 186TH Street Fresh Meadows,
Queens, NY 11365
Mailing address
223 23Rd St Apt 3L
Brooklyn, NY 11232-1346
Phone (315) 975-3086
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 |
|---|---|---|---|
| 16791432 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1703548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703548800000",
"number": "1619746104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "223 23RD ST APT 3L",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112321346",
"telephone_number": "315-975-3086"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "61- 43 186TH STREET FRESH MEADOWS,",
"city": "QUEENS",
"state": "NY",
"postal_code": "11365",
"telephone_number": "929-200-7105"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "EVELYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-12-26",
"last_updated": "2023-12-26",
"certification_date": "2023-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "16791432",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Queens, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.