Provider Demographics
NPI:1144393430
Name:ROCKLAND PSYCHIATRIC CENTER
Entity Type:Organization
Organization Name:ROCKLAND PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST II
Authorized Official - Prefix:
Authorized Official - First Name:MIRLANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-343-6686
Mailing Address - Street 1:893 WURTSBORO MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WURTSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12790-2108
Mailing Address - Country:US
Mailing Address - Phone:845-888-8095
Mailing Address - Fax:
Practice Address - Street 1:45 ASHLEY AVE. BUILDING 57
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:845-343-6686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204760283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF30428Medicare UPIN