Provider Demographics
NPI:1629393350
Name:MELENDEZ, ROLANDO MARIO (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:MARIO
Last Name:MELENDEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:4323 COLDEN ST APT 10K
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5914
Mailing Address - Country:US
Mailing Address - Phone:347-696-4113
Mailing Address - Fax:347-696-4113
Practice Address - Street 1:9317 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7943
Practice Address - Country:US
Practice Address - Phone:718-424-1557
Practice Address - Fax:347-696-4113
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY006581213E00000X, 213EP1101X, 213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04072533Medicaid