Provider Demographics
NPI:1861014201
Name:RODRIGUEZ, JOSEPH XAVIER (PA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:XAVIER
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:MR
Other - First Name:JOSEPH
Other - Middle Name:XAVIER
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, PA
Mailing Address - Street 1:107 FIELDSTONE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3275
Mailing Address - Country:US
Mailing Address - Phone:908-494-3175
Mailing Address - Fax:
Practice Address - Street 1:1 CAMPUS RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4495
Practice Address - Country:US
Practice Address - Phone:908-494-3175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant