Healthcare Provider Details

I. General information

NPI: 1174073183
Provider Name (Legal Business Name): ROCKLAND THORACIC & VASCULAR ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5A MEDICAL PARK DR
POMONA NY
10970-3516
US

IV. Provider business mailing address

5A MEDICAL PARK DR
POMONA NY
10970-3516
US

V. Phone/Fax

Practice location:
  • Phone: 845-362-0075
  • Fax: 845-362-1716
Mailing address:
  • Phone: 845-362-0075
  • Fax: 845-362-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MARK E GINSBURG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 845-362-1081