Provider Demographics
NPI:1326472689
Name:ROLLING, KELVIN LEWIS
Entity Type:Individual
Prefix:MR
First Name:KELVIN
Middle Name:LEWIS
Last Name:ROLLING
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:KELVIN
Other - Middle Name:LEWIS
Other - Last Name:ROLLING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1279 RICHMOND AVE
Mailing Address - Street 2:22
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-1515
Mailing Address - Country:US
Mailing Address - Phone:347-876-6943
Mailing Address - Fax:
Practice Address - Street 1:358 SAINT MARKS PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2417
Practice Address - Country:US
Practice Address - Phone:718-727-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program