Provider Demographics
NPI:1467471821
Name:RODRIGUEZ, RICARDO E (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:E
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 1:318 E WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-2318
Mailing Address - Country:US
Mailing Address - Phone:908-245-2229
Mailing Address - Fax:908-245-2384
Practice Address - Street 1:318 E WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204-2318
Practice Address - Country:US
Practice Address - Phone:908-245-2229
Practice Address - Fax:908-245-2384
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA52970174400000X
NJ25MA05297000207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1707400Medicaid
NJ1707400Medicaid
NJRO461631Medicare PIN