Healthcare Provider Details

I. General information

NPI: 1215997036
Provider Name (Legal Business Name): VICTOR R RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 MEMORIAL PKWY SUITE 115
PHILLIPSBURG NJ
08865-2748
US

IV. Provider business mailing address

10 BRASS CASTLE RD
WASHINGTON NJ
07882-4327
US

V. Phone/Fax

Practice location:
  • Phone: 908-454-3737
  • Fax: 908-454-0402
Mailing address:
  • Phone: 908-835-1910
  • Fax: 908-835-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA52001
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: