Individual
MR. DERRICK LEMUEL RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
30 PROSPECT AVE, HACKENSACK, NJ 07601-1915
(551) 455-4453
Mailing address
30 PROSPECT AVE, HACKENSACK, NJ 07601-1915
(551) 455-4453
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
26NJ01121100
NJ
363LA2200X
Adult Health Nurse Practitioner
Primary
26NJ01121100
NJ
Other
Enumeration date
02/27/2021
Last updated
02/15/2023
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