MEDICARE: EDDY ROJO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0019X	Physical Rehabilitation Occupational Therapist	46TR01059800	NJ

General Provider Information

NPI Number	:	1275279473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDDY ROJO

Provider Business Mailing Address
First Line	:	1515 88TH ST
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-4362
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 88TH ST
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-4362
Country	:	US
Telephone Number	:	201-988-8665
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2022
Last Update Date	:	05/10/2022

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Directions to “ EDDY ROJO ” Practice Location

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