1871542753 NPI number — COUNTY OF ROCKLAND, DEPARTMENT OF HEALTH

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 1871542753 NPI number — COUNTY OF ROCKLAND, DEPARTMENT OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF ROCKLAND, DEPARTMENT OF HEALTH
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:
1871542753
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:
1 CLINTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NYACK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10960-4715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-358-2151
Provider Business Mailing Address Fax Number:
845-358-2158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COUNTY OF ROCKLAND, DEPARTMENT OF HEALTH
Provider Second Line Business Practice Location Address:
50 SANATORIUM ROAD, BUILDING D
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-364-2512
Provider Business Practice Location Address Fax Number:
845-364-2628
Provider Enumeration Date:
05/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SALAMA
Authorized Official First Name:
NABILA
Authorized Official Middle Name:
F
Authorized Official Title or Position:
MEDICAL PHYSICIAN
Authorized Official Telephone Number:
845-358-2151

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  157653-1 , 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)

  • Identifier: 01429125 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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