Healthcare Provider Details

I. General information

NPI: 1033234828
Provider Name (Legal Business Name): DWAYNE E. ROLLINS, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18718 LINDEN BLVD
SAINT ALBANS NY
11412-4026
US

IV. Provider business mailing address

12042 231ST ST
CAMBRIA HEIGHTS NY
11411-2220
US

V. Phone/Fax

Practice location:
  • Phone: 718-978-5447
  • Fax: 718-978-8752
Mailing address:
  • Phone: 718-978-5447
  • Fax: 718-978-8752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number222755
License Number StateNY

VIII. Authorized Official

Name: DR. DWAYNE ERIC ROLLINS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 718-978-5447