Provider Demographics
NPI:1699883918
Name:SOCOLOF, ROSLYN W (MD)
Entity type:Individual
Prefix:
First Name:ROSLYN
Middle Name:W
Last Name:SOCOLOF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSLYN
Other - Middle Name:SUE
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7880
Mailing Address - Country:US
Mailing Address - Phone:518-761-0300
Mailing Address - Fax:518-824-2388
Practice Address - Street 1:100 BROAD ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4349
Practice Address - Country:US
Practice Address - Phone:518-792-2223
Practice Address - Fax:518-792-8231
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01771897Medicaid
NY52975ZMedicare PIN
NYG53234Medicare UPIN