Basic Information
| Provider Information | |||||||||
| NPI: | 1093822090 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | MARLENE | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 E. NEW YORK AVE | ||||||||
| Address2: | 4TH FLOOR - SPG | ||||||||
| City: | SOMERS POINT | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096533994 | ||||||||
| FaxNumber: | 6099264311 | ||||||||
| Practice Location | |||||||||
| Address1: | 2605 SHORE RD | ||||||||
| Address2: | |||||||||
| City: | NORTHFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082252136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093655300 | ||||||||
| FaxNumber: | 6093655306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 02/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MA066529 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8364702 | 05 | NJ | MEDICAID |