1306128814 NPI number — ROCKLAND CHILDREN'S PSYCHIATRIC CENTER

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 1306128814 NPI number — ROCKLAND CHILDREN'S PSYCHIATRIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKLAND CHILDREN'S PSYCHIATRIC CENTER
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:
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:
1306128814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 FIRST AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGEBURG
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-680-4000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 PARROTT ROAD BUILDING 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST NYACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10994
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-623-0085
Provider Business Practice Location Address Fax Number:
845-627-6302
Provider Enumeration Date:
09/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SHERIDAN
Authorized Official First Name:
BRENDAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHIATRIC SOCIAL WORKER II
Authorized Official Telephone Number:
845-623-0085

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  2683502A , 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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