Provider Demographics
NPI:1003437401
Name:RODRIGUES, ROBERTA
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 LAFAYETTE BLVD STE 1100
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-4710
Mailing Address - Country:US
Mailing Address - Phone:203-683-5946
Mailing Address - Fax:203-306-4040
Practice Address - Street 1:354 STATE ST STE 4
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-5530
Practice Address - Country:US
Practice Address - Phone:203-683-5946
Practice Address - Fax:203-306-4040
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator