Provider Demographics
NPI:1558838482
Name:INFECTIOUS DISEASE CONSULTANT OF ROCKLAND, P.C.
Entity type:Organization
Organization Name:INFECTIOUS DISEASE CONSULTANT OF ROCKLAND, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHLET
Authorized Official - Middle Name:
Authorized Official - Last Name:TADELE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-693-2243
Mailing Address - Street 1:91 E SUNNYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-1016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:259 N MIDDLETOWN RD STE 1B
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty