Healthcare Provider Details

I. General information

NPI: 1467471821
Provider Name (Legal Business Name): RICARDO E RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 E WESTFIELD AVE
ROSELLE PARK NJ
07204-2318
US

IV. Provider business mailing address

318 E WESTFIELD AVE
ROSELLE PARK NJ
07204-2361
US

V. Phone/Fax

Practice location:
  • Phone: 908-245-2229
  • Fax: 908-245-2384
Mailing address:
  • Phone: 908-245-2229
  • Fax: 833-973-5682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA05297000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA52970
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: