Provider Demographics
NPI:1013299247
Name:RODRIGO, ROSALIA MARCOS (CHHA-CNA)
Entity Type:Individual
Prefix:
First Name:ROSALIA
Middle Name:MARCOS
Last Name:RODRIGO
Suffix:
Gender:F
Credentials:CHHA-CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 AINSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-354-0089
Mailing Address - Fax:646-280-8424
Practice Address - Street 1:126 AINSWORTH AVE.
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-354-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NH12487200374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1210054768-01Medicaid
NJ195-14-4914AMedicare UPIN