Provider Demographics
NPI:1043370943
Name:ROCKLAND SURGICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:ROCKLAND SURGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAGDI
Authorized Official - Middle Name:F
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-735-6699
Mailing Address - Street 1:275 N MIDDLETOWN RD STE 1F
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1189
Mailing Address - Country:US
Mailing Address - Phone:845-735-6699
Mailing Address - Fax:845-735-7999
Practice Address - Street 1:275 N MIDDLETOWN RD STE 1F
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-1189
Practice Address - Country:US
Practice Address - Phone:845-735-6699
Practice Address - Fax:845-735-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149544208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4096768OtherAETNA
NYRS099OtherOXFORD INSURANCE
NY0096189OtherUS HEALTHCARE INSURANCE
NY00838862Medicaid
NY25D671Medicare ID - Type Unspecified
NY4096768OtherAETNA