Healthcare Provider Details

I. General information

NPI: 1710807888
Provider Name (Legal Business Name): JACQUELINE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 MOUNT PLEASANT AVE
WEST ORANGE NJ
07052-4901
US

IV. Provider business mailing address

2210 STELMASZEK RD
PARLIN NJ
08859-3209
US

V. Phone/Fax

Practice location:
  • Phone: 973-325-2266
  • Fax:
Mailing address:
  • Phone: 732-407-3389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26NR24226400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: