Individual
ROLAND GUILLERMO TAYABA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
79 01 BROADWAY, ROOM A1-9, ELMHURST, NY 11373-1329
(718) 334-4952
(718) 334-4815
Mailing address
79 01 BROADWAY, ROOM A1-9, ELMHURST, NY 11373-1329
(718) 334-4952
(718) 334-4815
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
182596
NY
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
182595
NY
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
182596
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01516650
—
NY
Enumeration date
07/10/2006
Last updated
10/23/2007
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