Healthcare Provider Details

I. General information

NPI: 1306877519
Provider Name (Legal Business Name): LIZA RODRIGUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 HIGHWAY 35
RED BANK NJ
07701-5920
US

IV. Provider business mailing address

939 FERNWOOD AVE
PLAINFIELD NJ
07062-2242
US

V. Phone/Fax

Practice location:
  • Phone: 732-842-2000
  • Fax:
Mailing address:
  • Phone: 973-698-0510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA07535000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number25MA07535000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: