Provider Demographics
NPI:1306875067
Name:ROLEN, PAUL BENJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BENJAMIN
Last Name:ROLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2166 BROADWAY APT 21A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6673
Mailing Address - Country:US
Mailing Address - Phone:212-396-2260
Mailing Address - Fax:954-698-6963
Practice Address - Street 1:2166 BROADWAY APT 21A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6673
Practice Address - Country:US
Practice Address - Phone:212-396-2260
Practice Address - Fax:954-698-6963
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1861212085D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00449080OtherRAILROAD MEDICARE
NY01818079Medicaid
NYE68241Medicare UPIN
NY01818079Medicaid
NY610551Medicare ID - Type Unspecified