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General NPI Number Information
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NPI Number | 1114969458
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE OF ROCKLAND PLLC
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 20 SQUADRON BLVD SUITE 350
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City | NEW CITY
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State | NY
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Zip | 10956-5200
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Country | US
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Telephone | 845-634-4567
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Fax | 845-634-4564
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Provider Business Mailing Address
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Address Line | 20 SQUADRON BLVD SUITE 350
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City | NEW CITY
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State | NY
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Zip | 10956-5200
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Country | US
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Telephone | 845-634-4567
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Fax | 845-634-4564
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Authorized Official
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Title or Position | OWNER
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Name | REENA J JACOB
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Credential | MD
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Telephone | 845-634-4567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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