Healthcare Provider Details

I. General information

NPI: 1457411266
Provider Name (Legal Business Name): ROCKLAND PSYCHIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 PLEASANT AVE
ENGLEWOOD NJ
07631-1604
US

IV. Provider business mailing address

140 PLEASANT AVE
ENGLEWOOD NJ
07631-1604
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-0908
  • Fax:
Mailing address:
  • Phone: 201-567-0908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number155047
License Number StateNY

VIII. Authorized Official

Name: DR. JESUS CANOZA SERRANO
Title or Position: MEDICAL SPECIALIST
Credential: M.D.
Phone: 845-358-1000