Healthcare Provider Details

I. General information

NPI: 1447889647
Provider Name (Legal Business Name): ALEJANDRO ISAAC RODARTE RASCON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 07/05/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BERGEN ST STE 5200
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

90 BERGEN ST STE 5200
NEWARK NJ
07103-2425
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-5209
  • Fax: 973-972-5059
Mailing address:
  • Phone: 973-972-5209
  • Fax: 973-972-5059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number25MA13176100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number25MA13176100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: