Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | D1447 | NJ |
NPI | 1053528661 |
---|---|
Provider Name | Carlos J Rodriguez |
First Address | Hackensack, NJ 07601-1709 |
Second Address | Union City, NJ 07087-3721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 09/07/2007 |