Provider Demographics
NPI:1154669513
Name:RODRIGUEZ, DANIEL ALEXANDER (ATC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALEXANDER
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 BRENDONA AVE
Mailing Address - Street 2:
Mailing Address - City:STANHOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07874-2026
Mailing Address - Country:US
Mailing Address - Phone:973-919-5470
Mailing Address - Fax:
Practice Address - Street 1:108 BILBY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-4174
Practice Address - Country:US
Practice Address - Phone:908-684-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-19
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ577321146N00000X
NJ25MT001721002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic