Provider Demographics
NPI:1386793446
Name:RODRIGUEZ, ELIZABETH S (RD)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:S
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 AUDREY PL
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-4812
Mailing Address - Country:US
Mailing Address - Phone:973-537-1474
Mailing Address - Fax:973-537-1474
Practice Address - Street 1:11 AUDREY PL
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-4812
Practice Address - Country:US
Practice Address - Phone:973-537-1474
Practice Address - Fax:973-537-1474
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDTO6983133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered