Individual provider Active NPI

Ellen Rodriguez, FNP

  • Family Nurse Practitioner
  • New York, NY
National Provider Identifier
1225892136
Registry record updated Mar 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
26NJ15017900 Issued in NJ
Practice address
30 Broad St
New York, NY 10004-2304
Phone
(888) 401-6582
NPI assigned
Feb 12, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 26NR20219700 NJ
Registered Nurse 163W00000X 767501 NY
Family Nurse Practitioner 363LF0000X 26NJ15017900 NJ Primary

Addresses

Primary practice location

30 Broad St
New York, NY 10004-2304

Mailing address

38 Townsend CT
Franklin Park, NJ 08823-1520
Phone (862) 324-4242

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240715004016 NJ Practitioner - Nurse Practitioner 6709321649 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NR20219700NJMDRegistered Nurse
767501NYMDRegistered Nurse
26NJ15017900NJMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Live Urgent Care LLC CurrentSince Jul 14, 2024 Accepting new patients
Signify Health Medical Associates of New Jersey, LLC CurrentSince Jun 1, 2024 Accepting new patients

Locations

363 W Browning Rd
Unit A
Bellmawr, NJ 08031
Phone (856) 333-3616

323 State St
Perth Amboy, NJ 08861
Phone (732) 484-4778

116 Village Blvd
Ste 200
Princeton, NJ 08540
Phone (609) 285-3094

85 Old Stage Rd
Spotswood, NJ 08884
Phone (732) 838-4940

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1707696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710288000000",
    "number": "1225892136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 TOWNSEND CT",
            "city": "FRANKLIN PARK",
            "state": "NJ",
            "postal_code": "088231520",
            "telephone_number": "862-324-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 BROAD ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100042304",
            "telephone_number": "888-401-6582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "ELLEN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-12",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NJ",
            "license": "26NR20219700",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "767501",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ15017900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.