Provider Demographics
NPI:1922047166
Name:ALONSO, RODOLFO (PA)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:ALONSO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:215 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1722
Mailing Address - Country:US
Mailing Address - Phone:732-545-0400
Mailing Address - Fax:732-545-0465
Practice Address - Street 1:4810 BELMAR BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-6952
Practice Address - Country:US
Practice Address - Phone:732-774-3880
Practice Address - Fax:732-545-0465
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00048400363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01253234OtherRR MEDICARE
NJ273184BC1Medicare PIN
NJP38063Medicare UPIN