Healthcare Provider Details

I. General information

NPI: 1215793419
Provider Name (Legal Business Name): STACEE LEVINE RODRIGUEZ APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BERGEN ST
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

2301 LENOX DR
WILLINGBORO NJ
08046-2588
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-9000
  • Fax:
Mailing address:
  • Phone: 609-367-2807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number26NJ14977600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: