MEDICARE: DR. ROLLAND NEMIROVSKY DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NS0005X	Sports Physician Chiropractor	11709	NY

General Provider Information

NPI Number	:	1093945842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROLLAND NEMIROVSKY DC

Provider Business Mailing Address
First Line	:	635 MADISON AVE
Second Line	:	SUITE 400
City	:	NEW YORK
State	:	NY
Zip	:	10022-1009
Country	:	US
Telephone Number	:	212-310-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	635 MADISON AVENUE
Second Line	:	SUITE 400
City	:	NEW YORK
State	:	NY
Zip	:	10022-2614
Country	:	US
Telephone Number	:	212-310-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	09/22/2011

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