Provider Demographics
NPI:1144201302
Name:RHODES, MICHAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:RHODES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-2441
Mailing Address - Country:US
Mailing Address - Phone:973-336-9459
Mailing Address - Fax:973-883-0144
Practice Address - Street 1:165 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-2441
Practice Address - Country:US
Practice Address - Phone:973-336-9459
Practice Address - Fax:973-883-0144
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2022-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246594207L00000X
NJ25MA08349100207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0165786Medicaid
NY03107568Medicaid
NYA400011376Medicare PIN
NYA400011381Medicare PIN
NY03107568Medicaid
NYA400011366Medicare PIN
NJ124016RJ0Medicare PIN
F73284Medicare UPIN
NYA400011369Medicare PIN
NYA400011374Medicare PIN
NYA400011371Medicare PIN
NYG400002004Medicare PIN
NYA400011377Medicare PIN