MEDICARE: MR. RODOLFO MALDONADO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service	25MA07792000	NJ
2	207R00000X	Internal Medicine Physician	25MA07792000	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00780649	OTHER	NJ	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093823668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RODOLFO MALDONADO M.D.

Provider Business Mailing Address
First Line	:	408 NEW BRUNSWICK AVE
Second Line	:
City	:	FORDS
State	:	NJ
Zip	:	08863-2110
Country	:	US
Telephone Number	:	732-826-1609
Fax Number	:	732-826-0075

Provider Business Practice Location Address
First Line	:	408 NEW BRUNSWICK AVE
Second Line	:
City	:	FORDS
State	:	NJ
Zip	:	08863-2110
Country	:	US
Telephone Number	:	732-826-1609
Fax Number	:	732-826-0075

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	06/10/2020

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