Provider Demographics
NPI:1578681672
Name:ROCKLAND CHILDREN'S PSYCHIATRIC CENTER
Entity type:Organization
Organization Name:ROCKLAND CHILDREN'S PSYCHIATRIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ATTENDING PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:MUSTAQ
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:SIDDIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-680-3633
Mailing Address - Street 1:69 GREENVALE CIR
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1601
Mailing Address - Country:US
Mailing Address - Phone:914-831-9155
Mailing Address - Fax:
Practice Address - Street 1:111 NORTH CENTRAL AVE
Practice Address - Street 2:SUITE #421
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530
Practice Address - Country:US
Practice Address - Phone:914-997-1789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229587283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital