Provider Demographics
NPI:1235228537
Name:NUNEZ, AIDA RODRIGO (MD)
Entity Type:Individual
Prefix:DR
First Name:AIDA
Middle Name:RODRIGO
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SULLIVAN WAY
Mailing Address - Street 2:
Mailing Address - City:WEST TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3406
Mailing Address - Country:US
Mailing Address - Phone:609-633-1562
Mailing Address - Fax:
Practice Address - Street 1:301 SULLIVAN WAY
Practice Address - Street 2:
Practice Address - City:WEST TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08628-3406
Practice Address - Country:US
Practice Address - Phone:609-633-1562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA052858002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ716757C2DOtherMEDICARE PROVIDER NUMBER
NJF21889Medicare UPIN