Healthcare Provider Details

I. General information

NPI: 1376334789
Provider Name (Legal Business Name): RODEL SOMIDO DONGUYA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WHITESVILLE RD STE A
TOMS RIVER NJ
08753-4105
US

IV. Provider business mailing address

350 CORBIN CT
LAKEWOOD NJ
08701-7444
US

V. Phone/Fax

Practice location:
  • Phone: 732-797-2505
  • Fax: 732-797-2506
Mailing address:
  • Phone: 732-581-4511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number26NR24028700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number26NR24028700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number809002
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: