Provider Demographics
NPI:1508607128
Name:RODRIGUEZ, SANTIAGO MARTIN (NP)
Entity type:Individual
Prefix:MR
First Name:SANTIAGO
Middle Name:MARTIN
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 BLOOMFIELD AVE APT 5G
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5416
Mailing Address - Country:US
Mailing Address - Phone:973-525-6894
Mailing Address - Fax:
Practice Address - Street 1:750 VALLEY BROOK AVE # 7071
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-1301
Practice Address - Country:US
Practice Address - Phone:201-896-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15050200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily