Provider Demographics
NPI:1902229693
Name:ROLANDO M. MELENDEZ DPM PC
Entity Type:Organization
Organization Name:ROLANDO M. MELENDEZ DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:M
Authorized Official - Last Name:MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:347-696-4113
Mailing Address - Street 1:4323 COLDEN ST APT 10N
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:347-696-4113
Practice Address - Fax:347-696-4113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006580213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04072533Medicaid
NY04072533Medicaid