Healthcare Provider Details

I. General information

NPI: 1629550074
Provider Name (Legal Business Name): LIZA RODRIGUEZ, MD. LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2018
Last Update Date: 01/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 MAIN STREET
SOUTH BOUND BROOK NJ
08880
US

IV. Provider business mailing address

PO BOX 24068
BELFAST ME
04915-4491
US

V. Phone/Fax

Practice location:
  • Phone: 732-690-0503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: LIZA RODRIGUEZ
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 732-690-0503