Provider Demographics
NPI:1972524916
Name:ROCKLAND EAR, NOSE, & THROAT ASSOC., P.C.
Entity Type:Organization
Organization Name:ROCKLAND EAR, NOSE, & THROAT ASSOC., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-272-1340
Mailing Address - Street 1:2 STRAWTOWN RD
Mailing Address - Street 2:SUITES 6 & 7
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1847
Mailing Address - Country:US
Mailing Address - Phone:845-727-1340
Mailing Address - Fax:845-727-1349
Practice Address - Street 1:2 STRAWTOWN RD
Practice Address - Street 2:SUITES 6 & 7
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1847
Practice Address - Country:US
Practice Address - Phone:845-727-1340
Practice Address - Fax:845-727-1349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173585207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW18921Medicare ID - Type Unspecified