Provider Demographics
NPI:1346257979
Name:ROCKLAND ORTHOPEDICS AND SPORTS MEDICINE PC
Entity Type:Organization
Organization Name:ROCKLAND ORTHOPEDICS AND SPORTS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTION/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ELYSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:M
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-356-2900
Mailing Address - Street 1:327 ROUTE 59
Mailing Address - Street 2:COLONIAL SQUARE
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3420
Mailing Address - Country:US
Mailing Address - Phone:845-356-2900
Mailing Address - Fax:845-356-7797
Practice Address - Street 1:327 ROUTE 59
Practice Address - Street 2:COLONIAL SQUARE
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-3420
Practice Address - Country:US
Practice Address - Phone:845-356-2900
Practice Address - Fax:845-356-7797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179160174400000X
NY213531174400000X
NY086369174400000X
NY160306174400000X
NY187591174400000X
NY202294174400000X
NY235899174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCA9479OtherRAILROAD MEDICARE GROUP #
NY0475172OtherAETNA HMO GROUP #
NY8459449OtherAETNA PPO GROUP#
NYCA9479OtherRAILROAD MEDICARE GROUP #
NYCA9479OtherRAILROAD MEDICARE GROUP #
NYW13491Medicare PIN