MEDICARE: DR. HECTOR A RODRIGUEZ M.D.

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	207L00000X	Anesthesiology Physician	25MA03823900	NJ

General Provider Information

NPI Number	:	1861487076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HECTOR A RODRIGUEZ M.D.

Provider Business Mailing Address
First Line	:	530 COVINGTON PL
Second Line	:
City	:	WYCKOFF
State	:	NJ
Zip	:	07481-1350
Country	:	US
Telephone Number	:	201-891-4705
Fax Number	:

Provider Business Practice Location Address
First Line	:	THE VALLEY HOSPITAL
Second Line	:	223 NORTH VAN DIEN AVENUE
City	:	RIDGEWOOD
State	:	NJ
Zip	:	07450-2736
Country	:	US
Telephone Number	:	201-447-8350
Fax Number	:

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/08/2007

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