Most Relevant Information
Provider Data
| NPI Number: | 1003064510 |
| Provider Name: | WILTON IVAN RODRIGUEZ M.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/09/2008 |
| Last Updated: | 09/09/2008 |
Provider Practice Location
144 W 12TH ST
NEW YORK
NY
100118202
Practice Location Phone/Fax
| Phone: | 2126047778 |
| Fax: |
Provider Mailing Location
234 10TH ST APT 510
JERSEY CITY
NJ
073021431
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |