Provider Demographics
NPI:1851360663
Name:DIAZ, RODOLFO (MD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:
Last Name:DIAZ
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 1:1206 W SHERMAN AVE
Mailing Address - Street 2:BLDG 2 SUITE B
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-6916
Mailing Address - Country:US
Mailing Address - Phone:856-696-5510
Mailing Address - Fax:856-696-5590
Practice Address - Street 1:1206 W SHERMAN AVE STE 2B
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6911
Practice Address - Country:US
Practice Address - Phone:856-696-5510
Practice Address - Fax:856-696-5590
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04900200174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5281300Medicaid
NJP387263OtherOXFORD
NJ01000270500OtherAMERICHOICE
NJ1002541OtherRAILROAD MEDICARE
NJ2025389OtherAETNA
NJHORIZON NJ HEALTHOther1079307
NJAMERIHEALTHOther0393811000
NJ1002541OtherUNITED HEALTH CARE
NJ572317Medicare ID - Type Unspecified
NJ5281300Medicaid