Healthcare Provider Details

I. General information

NPI: 1407781321
Provider Name (Legal Business Name): STEPHANIE LILIANA RODRIGUEZ R.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 COUNTY ROUTE 515
VERNON NJ
07462-3002
US

IV. Provider business mailing address

421 COUNTY ROUTE 515
VERNON NJ
07462-3002
US

V. Phone/Fax

Practice location:
  • Phone: 973-905-3822
  • Fax:
Mailing address:
  • Phone: 973-905-3822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C1101X
TaxonomyCardiovascular-Interventional Technology Radiologic Technologist
License Number658982
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: