Provider Demographics
NPI:1518056332
Name:INFECTIOUS DISEASES OF NEW JERSEY, LLC
Entity Type:Organization
Organization Name:INFECTIOUS DISEASES OF NEW JERSEY, LLC
Other - Org Name:ANA M. RODRIGUEZ-DIAZ, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RODRIGUEZ-DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-926-6899
Mailing Address - Street 1:PO BOX 5733
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-7733
Mailing Address - Country:US
Mailing Address - Phone:201-926-6899
Mailing Address - Fax:
Practice Address - Street 1:1119 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-2501
Practice Address - Country:US
Practice Address - Phone:201-926-6899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 064780207R00000X
NJMA064780207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7269005Medicaid
NJ093315Medicare ID - Type Unspecified