Provider Demographics
NPI:1093825945
Name:FIGUEREDO, ROLAND JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:JOSEPH
Last Name:FIGUEREDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E 72ND ST
Mailing Address - Street 2:17E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4650
Mailing Address - Country:US
Mailing Address - Phone:914-346-5175
Mailing Address - Fax:914-346-5176
Practice Address - Street 1:515 AUDUBON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3403
Practice Address - Country:US
Practice Address - Phone:917-513-9279
Practice Address - Fax:914-346-5176
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119118207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00222775Medicaid
NY00222775Medicaid
NYE20026Medicare UPIN