Provider Demographics
NPI:1740508829
Name:ROLANDO SOUSA MD, PC
Entity type:Organization
Organization Name:ROLANDO SOUSA MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-222-4653
Mailing Address - Street 1:330 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2728
Mailing Address - Country:US
Mailing Address - Phone:973-222-4653
Mailing Address - Fax:732-391-5115
Practice Address - Street 1:330 GRAND ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2728
Practice Address - Country:US
Practice Address - Phone:973-222-4653
Practice Address - Fax:732-391-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0092886Medicaid