Provider Demographics
NPI:1962445411
Name:ROLAND, JOHN T JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:ROLAND
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:THOMAS
Other - Last Name:ROLAND
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:550 1ST AVE
Mailing Address - Street 2:SUITE 8S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-263-5565
Mailing Address - Fax:212-263-2019
Practice Address - Street 1:550 1ST AVE
Practice Address - Street 2:SUITE 8S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-5565
Practice Address - Fax:212-263-2019
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159598207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
49I041Medicare PIN