Basic Information
| Provider Information | |||||||||
| NPI: | 1407857824 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PASCUAL | ||||||||
| FirstName: | RODOLFO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT HOLLY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080602043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092677050 | ||||||||
| FaxNumber: | 6092679653 | ||||||||
| Practice Location | |||||||||
| Address1: | 131 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT HOLLY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080602043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092677050 | ||||||||
| FaxNumber: | 6092679653 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 08/25/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25MA02621500 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2118807 | 05 | NJ | MEDICAID |