Provider Demographics
NPI:1356516900
Name:ROCKLAND INFECTIOUS DISEASE MEDICAL PRACTICE P. C
Entity type:Organization
Organization Name:ROCKLAND INFECTIOUS DISEASE MEDICAL PRACTICE P. C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FOLUKE
Authorized Official - Middle Name:O
Authorized Official - Last Name:SALU
Authorized Official - Suffix:
Authorized Official - Credentials:IMD
Authorized Official - Phone:845-624-4057
Mailing Address - Street 1:259 N MIDDLETOWN RD
Mailing Address - Street 2:SUITE1 B
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1220
Mailing Address - Country:US
Mailing Address - Phone:845-624-4057
Mailing Address - Fax:845-624-4059
Practice Address - Street 1:259 N MIDDLETOWN RD
Practice Address - Street 2:SUITE1 B
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-1220
Practice Address - Country:US
Practice Address - Phone:845-624-4057
Practice Address - Fax:845-624-4059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189907207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEM051Medicare PIN