Provider Demographics
NPI:1265468151
Name:RODRICKS, BALTAZAR D (MD)
Entity Type:Individual
Prefix:DR
First Name:BALTAZAR
Middle Name:D
Last Name:RODRICKS
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:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-0237
Mailing Address - Country:US
Mailing Address - Phone:609-813-2190
Mailing Address - Fax:
Practice Address - Street 1:6314 BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5543
Practice Address - Country:US
Practice Address - Phone:609-813-2190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02514600207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF00220Medicare UPIN
NJ401011U4RMedicare ID - Type Unspecified