Healthcare Provider Details

I. General information

NPI: 1063759587
Provider Name (Legal Business Name): KATHLEEN ROLDAN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 MERRICK RD
SEAFORD NY
11783-2823
US

IV. Provider business mailing address

3939 MERRICK RD
SEAFORD NY
11783-2823
US

V. Phone/Fax

Practice location:
  • Phone: 516-781-7777
  • Fax: 516-781-3252
Mailing address:
  • Phone: 516-781-7777
  • Fax: 516-781-3252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number662163
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: