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:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-8054
Mailing Address - Country:US
Mailing Address - Phone:347-696-4113
Mailing Address - Fax:347-696-4113
Practice Address - Street 1:5213 ROOSEVELT AVE FL 1
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-8054
Practice Address - Country:US
Practice Address - Phone:347-696-4113
Practice Address - Fax:347-696-4113
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006581213ES0103X, 213E00000X, 213ES0131X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04072533Medicaid