Provider Demographics
NPI:1063418192
Name:SILVERSTEIN, RODGER H (MD)
Entity type:Individual
Prefix:DR
First Name:RODGER
Middle Name:H
Last Name:SILVERSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 PASSAIC AVE
Mailing Address - Street 2:STE 17
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1804
Mailing Address - Country:US
Mailing Address - Phone:973-473-1515
Mailing Address - Fax:973-473-4811
Practice Address - Street 1:777 PASSAIC AVE
Practice Address - Street 2:STE 17
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1804
Practice Address - Country:US
Practice Address - Phone:973-473-1515
Practice Address - Fax:973-473-4811
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA37843174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3627102Medicaid
NJ3627102Medicaid
NJ528154Medicare ID - Type UnspecifiedGROUP ID