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General NPI Number Information
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NPI Number | 1457440208
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Entity Type | Individual
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Provider Name | RODERICK JAMES PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 4755 OGLETOWN STANTON ROAD SUITE 1320
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City | NEWARK
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State | DE
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Zip | 19718-2200
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Country | US
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Telephone | 302-733-4280
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Fax | 302-733-4287
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Provider Business Mailing Address
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Address Line | 1569 BRUCKNER BLVD APT 2F
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City | BRONX
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State | NY
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Zip | 10472-6436
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Country | US
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Telephone | 917-270-0547
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C5-0012053
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 008516
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License Number State | NY
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