Healthcare Provider Details

I. General information

NPI: 1952165003
Provider Name (Legal Business Name): JOSEPHINE VANESSA RODRIGUEZ PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 MOUNT PROSPECT AVE
NEWARK NJ
07104-2904
US

IV. Provider business mailing address

35 STRATFORD RD
DUMONT NJ
07628-1123
US

V. Phone/Fax

Practice location:
  • Phone: 201-925-7633
  • Fax:
Mailing address:
  • Phone: 201-925-7633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15044500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: