1639240179 NPI number — ROCKLAND NUCLEAR SPECT IMAGING, PC

Table of content: (NPI 1639240179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639240179 NPI number — ROCKLAND NUCLEAR SPECT IMAGING, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKLAND NUCLEAR SPECT IMAGING, PC
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:
1639240179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13125
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAUPPAUGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11788-0560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-454-5545
Provider Business Mailing Address Fax Number:
845-454-6992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2656 SOUTH RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
POUGHKEEPSIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12601-5279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-545-5545
Provider Business Practice Location Address Fax Number:
845-545-6992
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAYER
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, MANAGED CARE & CREDENTIALING
Authorized Official Telephone Number:
631-952-5717

Provider Taxonomy Codes

  • Taxonomy code: 207UN0901X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02082942 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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