Healthcare Provider Details

I. General information

NPI: 1528978095
Provider Name (Legal Business Name): RODRIGUE JEROME
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2933 VAUXHALL RD STE 7
VAUXHALL NJ
07088-1248
US

IV. Provider business mailing address

2933 VAUXHALL RD STE 7
VAUXHALL NJ
07088-1248
US

V. Phone/Fax

Practice location:
  • Phone: 732-558-5289
  • Fax:
Mailing address:
  • Phone: 732-558-5289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberJ27326640012642
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: