Provider Demographics
NPI:1649413782
Name:RODRIGUEZ, HERNAN (SPECIAL EDUCATOR)
Entity Type:Individual
Prefix:MR
First Name:HERNAN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:SPECIAL EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 74TH ST
Mailing Address - Street 2:APT. C-8
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-4096
Mailing Address - Country:US
Mailing Address - Phone:201-203-7221
Mailing Address - Fax:201-203-7221
Practice Address - Street 1:1604 74TH ST
Practice Address - Street 2:APT. C-8
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4096
Practice Address - Country:US
Practice Address - Phone:201-203-7221
Practice Address - Fax:201-203-7221
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency