Provider Demographics
NPI:1093728289
Name:ROLAND, DONALD
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:ROLAND
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 1:52 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4266
Mailing Address - Country:US
Mailing Address - Phone:212-744-9400
Mailing Address - Fax:
Practice Address - Street 1:52 E 72ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4266
Practice Address - Country:US
Practice Address - Phone:212-744-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2010302086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02269134Medicaid
NY39L081Medicare ID - Type Unspecified
NY02269134Medicaid