Individual ProviderDavid RodriguezSocial WorkerBehavioral Health & Social Service ProvidersPractice Address93 W Palisade Ave, Englewood, NJ 07631-2611(201) 567-0500(201) 421-0515PECOS EnrollmentBased on the most recent information from CMS, provider David Rodriguez is legally eligible to order and refer claims for DME services only.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:47 AM.Profile DetailsProvider ID1194242453Provider TypeIndividualFull NameRodriguez, DavidTitleMr.CredentialLCSWGenderMaleSole ProprietorNoEnumeration Date8/28/2017Last Updated6/16/2021Contact InformationPractice LocationPractice Address93 W Palisade Ave, Englewood, NJ 07631-2611Phone(201) 567-0500FaxUnlisted FaxMailing LocationMailing Address8325 Kennedy Blvd, Apt 3b, North Bergen, NJ 07047-4258Phone(201) 421-0515FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense44SC05826000New Jersey