Healthcare Provider Details

I. General information

NPI: 1760680573
Provider Name (Legal Business Name): ROSITA RODRIGUEZ DNP, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 BROADWAY
WEST NEW YORK NJ
07093-2622
US

IV. Provider business mailing address

1 RUSTIC RIDGE RD APT. A-13
LITTLE FALLS NJ
07424-1965
US

V. Phone/Fax

Practice location:
  • Phone: 201-866-9320
  • Fax: 201-866-7588
Mailing address:
  • Phone: 973-800-2434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00142000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NO12393800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00142000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: