Provider Demographics
NPI:1801694963
Name:RODRIGUEZ, JOHNNY
Entity type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JOHNNY
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:55 STILLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1229
Mailing Address - Country:US
Mailing Address - Phone:646-373-1604
Mailing Address - Fax:
Practice Address - Street 1:55 STILLMAN AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1229
Practice Address - Country:US
Practice Address - Phone:646-373-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter