Healthcare Provider Details

I. General information

NPI: 1093945842
Provider Name (Legal Business Name): ROLLAND NEMIROVSKY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 MADISON AVENUE SUITE 400
NEW YORK NY
10022-2614
US

IV. Provider business mailing address

635 MADISON AVE SUITE 400
NEW YORK NY
10022-1009
US

V. Phone/Fax

Practice location:
  • Phone: 212-310-0100
  • Fax:
Mailing address:
  • Phone: 212-310-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number11709
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: