Provider Demographics
NPI:1114969458
Name:INTERNAL MEDICINE OF ROCKLAND PLLC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF ROCKLAND PLLC
Other - Org Name:REENA JACOB MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REENA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-634-4567
Mailing Address - Street 1:20 SQUADRON BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5200
Mailing Address - Country:US
Mailing Address - Phone:845-634-4567
Mailing Address - Fax:845-634-4564
Practice Address - Street 1:20 SQUADRON BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5200
Practice Address - Country:US
Practice Address - Phone:845-634-4567
Practice Address - Fax:845-634-4564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02148603Medicaid
NYWDW921Medicare ID - Type Unspecified
NYH34396Medicare UPIN