Provider Demographics
NPI:1679950596
Name:ROCKLAND BEHAVIORAL MEDICINE PLLC
Entity Type:Organization
Organization Name:ROCKLAND BEHAVIORAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NNAMDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MADUEKWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-286-9770
Mailing Address - Street 1:81 HALLEY DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2109
Mailing Address - Country:US
Mailing Address - Phone:646-286-9770
Mailing Address - Fax:
Practice Address - Street 1:141 S LIBERTY DR
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-2422
Practice Address - Country:US
Practice Address - Phone:845-241-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244833261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty