Healthcare Provider Details

I. General information

NPI: 1972820330
Provider Name (Legal Business Name): ANDY RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S ORANGE AVE SUITE 101
LIVINGSTON NJ
07039-5817
US

IV. Provider business mailing address

200 S ORANGE AVE SUITE 101
LIVINGSTON NJ
07039-5817
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-7580
  • Fax: 973-322-7505
Mailing address:
  • Phone: 973-322-7580
  • Fax: 973-322-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number25MA09318400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number25MA09318400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number25MA09318400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: