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General NPI Number Information
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NPI Number | 1114769619
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Entity Type | Individual
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Provider Name | MABEL L RODRIGUEZ NP
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Gender | Female
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 1 CLARA MAASS DR
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City | BELLEVILLE
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State | NJ
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Zip | 07109-3550
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Country | US
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Telephone | 973-450-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 264 ARGYLE PL
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City | KEARNY
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State | NJ
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Zip | 07032-3219
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Country | US
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Telephone | 201-349-6459
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 26NR15083900
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License Number State | NJ
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