Healthcare Provider Details

I. General information

NPI: 1619768686
Provider Name (Legal Business Name): TINESHA RODRIGUES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 SPRINGFIELD AVE STE 2
MAPLEWOOD NJ
07040-3438
US

IV. Provider business mailing address

1980 SPRINGFIELD AVE STE 2
MAPLEWOOD NJ
07040-3438
US

V. Phone/Fax

Practice location:
  • Phone: 201-779-5722
  • Fax: 201-779-5722
Mailing address:
  • Phone: 862-346-0424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number2026-0928
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHP0403100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: