MEDICARE: DR. RENEE ROLSTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	35.146043	OH
2	207VF0040X	Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician	280537	NY

General Provider Information

NPI Number	:	1497099857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENEE ROLSTON MD

Provider Business Mailing Address
First Line	:	525 E 68TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-4870
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 E 68TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-4870
Country	:	US
Telephone Number	:	646-962-5913
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2012
Last Update Date	:	03/15/2026

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