Provider Demographics
NPI:1326144213
Name:ROSE, ROLAND (DC)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:
Last Name:ROSE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:ROLAND
Other - Middle Name:
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:10825 MERRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-2906
Mailing Address - Country:US
Mailing Address - Phone:718-658-9700
Mailing Address - Fax:718-658-9703
Practice Address - Street 1:10825 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-2906
Practice Address - Country:US
Practice Address - Phone:718-658-9700
Practice Address - Fax:718-658-9703
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010712111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06486Medicare UPIN