Provider Demographics
NPI:1316925431
Name:ROCKLAND INFECTIOUS DISEASE, LLP
Entity type:Organization
Organization Name:ROCKLAND INFECTIOUS DISEASE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:P. C. TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-358-1344
Mailing Address - Street 1:2 CROSFIELD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2226
Mailing Address - Country:US
Mailing Address - Phone:845-358-1344
Mailing Address - Fax:845-358-8073
Practice Address - Street 1:2 CROSFIELD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2226
Practice Address - Country:US
Practice Address - Phone:845-358-1344
Practice Address - Fax:845-358-8073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02685367Medicare ID - Type UnspecifiedGROUP NUMBER
NYWES611Medicare ID - Type UnspecifiedGROUP NUMBER
DC6435Medicare PIN