Provider Demographics
NPI:1710046768
Name:MID-ROCKLAND MEDICAL GROUP PC
Entity Type:Organization
Organization Name:MID-ROCKLAND MEDICAL GROUP PC
Other - Org Name:BESTCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-623-4000
Mailing Address - Street 1:104 E ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2957
Mailing Address - Country:US
Mailing Address - Phone:845-623-4000
Mailing Address - Fax:845-623-5309
Practice Address - Street 1:104 E ROUTE 59
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2957
Practice Address - Country:US
Practice Address - Phone:845-623-4000
Practice Address - Fax:845-623-5309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTID
NYWAA361Medicare ID - Type Unspecified