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NPI Code Detail

MEDICARE: ROCKLAND SURGICAL ASSOCIATES, P.C.

MEDICARE: ROCKLAND SURGICAL ASSOCIATES, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician149544NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14096768OTHERNYAETNA
2RS099OTHERNYOXFORD INSURANCE
30096189OTHERNYUS HEALTHCARE INSURANCE
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043370943
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROCKLAND SURGICAL ASSOCIATES, P.C.
Provider Business Mailing Address
First Line : 275 N MIDDLETOWN RD STE 1F
Second Line :
City : PEARL RIVER
State : NY
Zip : 10965-1189
Country : US
Telephone Number : 845-735-6699
Fax Number : 845-735-7999
Provider Business Practice Location Address
First Line : 275 N MIDDLETOWN RD STE 1F
Second Line :
City : PEARL RIVER
State : NY
Zip : 10965-1189
Country : US
Telephone Number : 845-735-6699
Fax Number : 845-735-7999
Authorized Official
Title or Position : PRESIDENT
Name : WAGDI F IBRAHIM
Credential : M.D.
Telephone Number : 845-735-6699
Provider Enumeration Date : 12/11/2006
Last Update Date : 08/22/2020

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