Basic Information
| Provider Information | |||||||||
| NPI: | 1003012568 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODGERS | ||||||||
| FirstName: | SHAUN | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 LAKEVILLE RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110421101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163543401 | ||||||||
| FaxNumber: | 5163548597 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 LAKEVILLE RD | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110421101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163543401 | ||||||||
| FaxNumber: | 5163548597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 09/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 036134910 | IL | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 257509 | NY | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.