Provider Demographics
NPI:1639240179
Name:ROCKLAND NUCLEAR SPECT IMAGING, PC
Entity Type:Organization
Organization Name:ROCKLAND NUCLEAR SPECT IMAGING, PC
Other - Org Name:POUGHKEEPSIE CARDIAC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, MANAGED CARE & CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-952-5717
Mailing Address - Street 1:PO BOX 13125
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-0560
Mailing Address - Country:US
Mailing Address - Phone:845-454-5545
Mailing Address - Fax:845-454-6992
Practice Address - Street 1:2656 SOUTH RD
Practice Address - Street 2:SUITE B
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5279
Practice Address - Country:US
Practice Address - Phone:845-545-5545
Practice Address - Fax:845-545-6992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02082942Medicaid