Basic Information
Provider Information
NPI: 1043588130
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RODWELL
FirstName: REIA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 801 LINDEN BLVD
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112033517
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 9715 64TH RD
Address2:  
City: REGO PARK
State: NY
PostalCode: 113742250
CountryCode: US
TelephoneNumber: 7184595592
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/05/2011
LastUpdateDate: 12/05/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
164W00000X306921-1NYY Nursing Service ProvidersLicensed Practical Nurse 

No ID Information.


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