Provider Demographics
NPI:1912936121
Name:ROLLER, JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ROLLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 HARLEM RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4031
Mailing Address - Country:US
Mailing Address - Phone:716-893-7337
Mailing Address - Fax:716-893-7699
Practice Address - Street 1:2625 HARLEM RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4031
Practice Address - Country:US
Practice Address - Phone:716-893-7337
Practice Address - Fax:716-893-7699
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY229568208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY145776DLOtherPREFERRED CARE
NY000527405001OtherBLUE CROSS
NY1211730OtherINDEPENDENT HEALTH
NY00026491301OtherUNIVERA
NY050602000020OtherFIDELIS