Individual provider Active NPI

Victor R Rodriguez, MD

  • Pediatrics Physician
  • Phillipsburg, NJ
National Provider Identifier
1215997036
Registry record updated Jul 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MA52001 Issued in NJ
Practice address
755 Memorial Pkwy
Suite 115
Phillipsburg, NJ 08865-2748
Phone
(908) 454-3737
Fax
(908) 454-0402
NPI assigned
Mar 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MA52001 NJ Primary

Addresses

Primary practice location

755 Memorial Pkwy
Suite 115
Phillipsburg, NJ 08865-2748

Mailing address

10 Brass Castle Rd
Washington, NJ 07882-4327
Phone (908) 835-1910

Other identifiers 1

IdentifierTypeStateIssuer
4981600MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040426001223 NJ Practitioner - Pediatric Medicine 7719974559

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MA52001NJMDPediatrics Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184889600000",
    "number": "1215997036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 BRASS CASTLE RD",
            "city": "WASHINGTON",
            "state": "NJ",
            "postal_code": "078824327",
            "telephone_number": "908-835-1910",
            "fax_number": "908-835-1886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 MEMORIAL PKWY",
            "address_2": "SUITE 115",
            "city": "PHILLIPSBURG",
            "state": "NJ",
            "postal_code": "088652748",
            "telephone_number": "908-454-3737",
            "fax_number": "908-454-0402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "VICTOR",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2007-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "MA52001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4981600",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phillipsburg, NJ

Sources for this page

Verify at the official NPI Registry.