Provider Demographics
NPI:1407857824
Name:PASCUAL, RODOLFO (MD)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:PASCUAL
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 1:131 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2043
Mailing Address - Country:US
Mailing Address - Phone:609-267-7050
Mailing Address - Fax:609-267-9653
Practice Address - Street 1:131 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2043
Practice Address - Country:US
Practice Address - Phone:609-267-7050
Practice Address - Fax:609-267-9653
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02621500208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2118807Medicaid
NJ2118807Medicaid
NJ093098Medicare ID - Type Unspecified