Healthcare Provider Details

I. General information

NPI: 1356849392
Provider Name (Legal Business Name): ALFRED RODRIGUEZ PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 ROUTE 70 E STE B
MARLTON NJ
08053-1855
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-596-9057
  • Fax: 856-296-0837
Mailing address:
  • Phone: 856-596-9057
  • Fax: 856-596-0837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00537800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA061445
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: