Provider Demographics
NPI:1336172501
Name:ROCKLAND MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:ROCKLAND MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HALEVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-429-1800
Mailing Address - Street 1:2 SUFFERN LN
Mailing Address - Street 2:
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-1311
Mailing Address - Country:US
Mailing Address - Phone:845-429-1800
Mailing Address - Fax:845-947-4198
Practice Address - Street 1:2 SUFFERN LN
Practice Address - Street 2:
Practice Address - City:GARNERVILLE
Practice Address - State:NY
Practice Address - Zip Code:10923-1311
Practice Address - Country:US
Practice Address - Phone:845-429-1800
Practice Address - Fax:845-947-4198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173868207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW34981Medicare PIN