Provider Demographics
NPI:1366867475
Name:ROLDAN, PIEDAD
Entity Type:Individual
Prefix:
First Name:PIEDAD
Middle Name:
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 GARTH RD APT 3U
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3807
Mailing Address - Country:US
Mailing Address - Phone:914-912-2183
Mailing Address - Fax:
Practice Address - Street 1:188 GARTH RD APT 3U
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3807
Practice Address - Country:US
Practice Address - Phone:914-912-2183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY581315941174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist