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General NPI Number Information
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NPI Number | 1184778060
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Entity Type | Organization
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Legal Business Name | MORRIS AVENUE ENDOSCOPY LLC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 200 SHEFFIELD ST STE 101
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City | MOUNTAINSIDE
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State | NJ
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Zip | 07092-2315
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Country | US
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Telephone | 908-241-8900
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Fax | 908-241-8933
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Provider Business Mailing Address
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Address Line | 200 SHEFFIELD ST STE 101
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City | MOUNTAINSIDE
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State | NJ
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Zip | 07092-2315
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Country | US
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Telephone | 908-241-8900
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Fax | 908-241-8933
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | RICARDO E RODRIGUEZ
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Credential | MD
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Telephone | 908-241-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 22724
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License Number State |
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