Healthcare Provider Details

I. General information

NPI: 1215687454
Provider Name (Legal Business Name): CHRISTOPHER J RODAS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 W SHERMAN AVE
VINELAND NJ
08360-7059
US

IV. Provider business mailing address

1505 W SHERMAN AVE
VINELAND NJ
08360-7059
US

V. Phone/Fax

Practice location:
  • Phone: 856-641-6032
  • Fax: 856-575-4944
Mailing address:
  • Phone: 856-641-6032
  • Fax: 856-575-4944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number5151017581
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number25MB13071500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: