Provider Demographics
NPI:1245207281
Name:RODRIGUEZ, PASCUAL (MD)
Entity Type:Individual
Prefix:DR
First Name:PASCUAL
Middle Name:
Last Name:RODRIGUEZ
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 1:2102 CORLIES AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6141
Mailing Address - Country:US
Mailing Address - Phone:732-776-8535
Mailing Address - Fax:732-774-9148
Practice Address - Street 1:215 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-5219
Practice Address - Country:US
Practice Address - Phone:732-222-1543
Practice Address - Fax:732-222-4862
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46803207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8560004Medicaid
NJ047596DQUMedicare ID - Type Unspecified
NJ8560004Medicaid