Provider Demographics
NPI:1477728582
Name:DR. RICARDO E. RODRIGUEZ, M.D, P.A.
Entity Type:Organization
Organization Name:DR. RICARDO E. RODRIGUEZ, M.D, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-245-2229
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA52970207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1707400Medicaid
NJ1707400Medicaid
NJE22032Medicare UPIN