Healthcare Provider Details

I. General information

NPI: 1144872730
Provider Name (Legal Business Name): STEFANY MORALES RODRIGUEZ DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 RAHWAY AVE
ELIZABETH NJ
07202-2212
US

IV. Provider business mailing address

1092 DEWEY PL
ELIZABETH NJ
07202-2426
US

V. Phone/Fax

Practice location:
  • Phone: 908-353-5750
  • Fax:
Mailing address:
  • Phone: 908-397-6962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ00934400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: