Healthcare Provider Details

I. General information

NPI: 1629393350
Provider Name (Legal Business Name): ROLANDO MARIO MELENDEZ DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5213 ROOSEVELT AVE FL 1
WOODSIDE NY
11377-8054
US

IV. Provider business mailing address

5213 ROOSEVELT AVE
WOODSIDE NY
11377-8054
US

V. Phone/Fax

Practice location:
  • Phone: 347-696-4113
  • Fax: 347-696-4113
Mailing address:
  • Phone: 347-696-4113
  • Fax: 347-696-4113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number006581
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number006581
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number006581
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number006581
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: