MEDICARE: ROCKWOOD PARTNERS, LLC

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
1	405300000X	Prevention Professional

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1831280411	OTHER	NY	NPI
3	1112891	OTHER	NY	DPRP ASSIGNED ORGANIZATION CODE
4	157094	OTHER	NY	MEDICAL LICENSE

General Provider Information

NPI Number	:	1184363566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKWOOD PARTNERS, LLC

Provider Business Mailing Address
First Line	:	154 COVE ST
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-6813
Country	:	US
Telephone Number	:	631-235-7727
Fax Number	:	646-365-3136

Provider Business Practice Location Address
First Line	:	225 E 57TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-2822
Country	:	US
Telephone Number	:	917-740-2311
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CASSANDRA E HENDERSON
Credential	:	MD
Telephone Number	:	917-620-5230

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	03/07/2023

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Directions to “ROCKWOOD PARTNERS, LLC ” Practice Location

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