1568895654 NPI number — ROCKLAND CENTER FOR VASCULAR SURGERY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568895654 NPI number — ROCKLAND CENTER FOR VASCULAR SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKLAND CENTER FOR VASCULAR SURGERY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568895654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
873 ROUTE 45
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
NEW CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10956-1116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-499-2333
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5A MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10970-3516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-362-0075
Provider Business Practice Location Address Fax Number:
845-362-7475
Provider Enumeration Date:
08/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GINSBURG
Authorized Official First Name:
MARK
Authorized Official Middle Name:
ELLIS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
845-362-1081

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  147810 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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