Provider Demographics
NPI:1912964537
Name:COLACO, RODOLFO (MD)
Entity type:Individual
Prefix:MR
First Name:RODOLFO
Middle Name:
Last Name:COLACO
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 1:431 ELMORA AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07208-1576
Mailing Address - Country:US
Mailing Address - Phone:908-353-4177
Mailing Address - Fax:908-353-7201
Practice Address - Street 1:431 ELMORA AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07208-1576
Practice Address - Country:US
Practice Address - Phone:908-353-4177
Practice Address - Fax:908-353-7201
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04519200208600000X, 2086S0129X, 2086S0105X, 208C00000X, 174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0359203Medicaid
NJ0359203Medicaid
NJ463189Medicare PIN