Provider Demographics
NPI:1093823668
Name:MALDONADO, RODOLFO (MD)
Entity type:Individual
Prefix:MR
First Name:RODOLFO
Middle Name:
Last Name:MALDONADO
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 1:408 NEW BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-2110
Mailing Address - Country:US
Mailing Address - Phone:732-826-1609
Mailing Address - Fax:732-826-0075
Practice Address - Street 1:408 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-2110
Practice Address - Country:US
Practice Address - Phone:732-826-1609
Practice Address - Fax:732-826-0075
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07792000305S00000X, 207R00000X
FLME 99208208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No305S00000XManaged Care OrganizationsPoint of Service
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0080012Medicaid
NJP00780649OtherRR MEDICARE
NJI45071Medicare UPIN
NJ0080012Medicaid
NJ095779S6SMedicare PIN