Provider Demographics
NPI:1184363566
Name:ROCKWOOD PARTNERS, LLC
Entity type:Organization
Organization Name:ROCKWOOD PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-620-5230
Mailing Address - Street 1:154 COVE ST
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-6813
Mailing Address - Country:US
Mailing Address - Phone:631-235-7727
Mailing Address - Fax:646-365-3136
Practice Address - Street 1:225 E 57TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2822
Practice Address - Country:US
Practice Address - Phone:917-740-2311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00965559Medicaid
NY1831280411OtherNPI
NY1112891OtherDPRP ASSIGNED ORGANIZATION CODE
NY157094OtherMEDICAL LICENSE
NY157094OtherMEDICAL LICENSE