Provider Demographics
NPI:1376597856
Name:ADVANCED RADIATION ONCOLOGY SERVICES OF ROCKLAND, PC
Entity Type:Organization
Organization Name:ADVANCED RADIATION ONCOLOGY SERVICES OF ROCKLAND, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WININGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-684-1633
Mailing Address - Street 1:1 LETHBRIDGE PLZ
Mailing Address - Street 2:SUITE #20
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-2126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1805
Practice Address - Country:US
Practice Address - Phone:845-727-0828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02162325Medicaid
NY02162325Medicaid