Healthcare Provider Details

I. General information

NPI: 1144310087
Provider Name (Legal Business Name): MICHAEL ROLLIN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 HARRIS BUSHVILLE RD
HARRIS NY
12742
US

IV. Provider business mailing address

68 HARRIS BUSHVILLE RD
HARRIS NY
12742
US

V. Phone/Fax

Practice location:
  • Phone: 845-791-7828
  • Fax: 845-794-3347
Mailing address:
  • Phone: 845-791-7828
  • Fax: 845-794-3347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF331600-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: