Provider Demographics
NPI:1174560197
Name:MOISES, RODULFO (MD)
Entity type:Individual
Prefix:DR
First Name:RODULFO
Middle Name:
Last Name:MOISES
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 1:703 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1824
Mailing Address - Country:US
Mailing Address - Phone:973-574-8060
Mailing Address - Fax:973-574-8061
Practice Address - Street 1:1040 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3511
Practice Address - Country:US
Practice Address - Phone:973-574-8060
Practice Address - Fax:973-574-8061
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA6309900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics