Provider Demographics
NPI:1003039496
Name:ROSLONSKI, RAYMOND P
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:P
Last Name:ROSLONSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-1228
Mailing Address - Country:US
Mailing Address - Phone:412-431-3139
Mailing Address - Fax:412-431-3144
Practice Address - Street 1:1221 E CARSON ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-1228
Practice Address - Country:US
Practice Address - Phone:412-431-3139
Practice Address - Fax:412-431-3144
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA156FX1800X156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA081009Medicaid
PAMA081009Medicaid