Provider Demographics
NPI:1063568053
Name:PREFERRED PEDIATRICS OF ROCKLAND, LLC
Entity type:Organization
Organization Name:PREFERRED PEDIATRICS OF ROCKLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIROP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-357-5020
Mailing Address - Street 1:100 ROUTE 59
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4927
Mailing Address - Country:US
Mailing Address - Phone:845-357-5020
Mailing Address - Fax:845-357-5033
Practice Address - Street 1:100 ROUTE 59
Practice Address - Street 2:SUITE 104
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4927
Practice Address - Country:US
Practice Address - Phone:845-357-5020
Practice Address - Fax:845-357-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100063174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0048210OtherAETNA HMO GROUP#
NY7868161OtherAETNA PPO GROUP #
NY=========OtherTAX ID#