Individual provider Active NPI

Jose Rodriguez, CASAC

  • Addiction (Substance Use Disorder) Counselor
  • Long Island City, NY
National Provider Identifier
1669915021
Registry record updated Dec 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
24157 Issued in NY
Practice address
2976 Northern Blvd FL 2
Long Island City, NY 11101-2829
Phone
(212) 691-7554
Fax
(347) 510-3457
NPI assigned
Dec 2, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 24157 NY Primary

Addresses

Primary practice location

2976 Northern Blvd FL 2
Long Island City, NY 11101-2829

Mailing address

2976 Northern Blvd FL 2
Long Island City, NY 11101-2829
Phone (212) 691-7554

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

LicenseStateTypeSpecialty
24157NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Fortune Society Inc. Addiction (Substance Use Disorder) PastSince Jan 4, 2012 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1480636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480636800000",
    "number": "1669915021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2976 NORTHERN BLVD FL 2",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111012829",
            "telephone_number": "212-691-7554",
            "fax_number": "347-510-3457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2976 NORTHERN BLVD FL 2",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111012829",
            "telephone_number": "212-691-7554",
            "fax_number": "347-510-3457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "JOSE",
        "credential": "CASAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-12-02",
        "last_updated": "2016-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "24157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Island City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.