Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 25MA04519200 | NJ |
N | 111NI0900X | Internist | 25MA04519200 | NJ |
Y | 208200000X | Surgeon | 25MA04519200 | NJ |
Y | 208600000X | Surgeon | 25MA04519200 | NJ |
N | 2086S0105X | Surgery of the Hand | 25MA04519200 | NJ |
N | 2086S0129X | Vascular Surgeon | 25MA04519200 | NJ |
N | 208C00000X | Colorectal Surgeon | 25MA04519200 | NJ |
NPI | 1912964537 |
---|---|
Provider Name | Mr. Rodolfo Colaco |
First Address | Elizabeth, NJ 07208-1576 |
Second Address | Elizabeth, NJ 07208-1576 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 28/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0359203 | (05) | NJ |
C56322 | (02) | NJ |