Provider Demographics
NPI:1306877519
Name:RODRIGUEZ, LIZA (MD)
Entity type:Individual
Prefix:DR
First Name:LIZA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 FERNWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07062-2242
Mailing Address - Country:US
Mailing Address - Phone:973-698-0510
Mailing Address - Fax:
Practice Address - Street 1:270 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5920
Practice Address - Country:US
Practice Address - Phone:732-842-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07535000207L00000X, 207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0036668Medicaid
NJP00241435OtherRAILROAD MEDICARE
NJH97977Medicare UPIN
NJ075269Medicare ID - Type Unspecified