Provider Demographics
NPI:1689745226
Name:ROCKLAND NUCLEAR SPECT IMAGING, PC
Entity Type:Organization
Organization Name:ROCKLAND NUCLEAR SPECT IMAGING, PC
Other - Org Name:NEWBURGH CARDIOVASCULAR 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:845-565-9086
Mailing Address - Fax:845-565-9872
Practice Address - Street 1:310 FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3724
Practice Address - Country:US
Practice Address - Phone:845-565-9086
Practice Address - Fax:845-565-9872
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
NYW24251Medicare ID - Type Unspecified