Basic Information
| Provider Information | |||||||||
| NPI: | 1073693594 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PURCELL | ||||||||
| FirstName: | ROLAND | ||||||||
| MiddleName: | ROYSTON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 661 EAST 84TH STREET | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112363427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187783311 | ||||||||
| FaxNumber: | 7189531178 | ||||||||
| Practice Location | |||||||||
| Address1: | 83 EAST 38TH STREET | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112032006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187783311 | ||||||||
| FaxNumber: | 7189531178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 03/03/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 157204 | NY | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 207P00000X | 157204 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 2086S0102X | 157204 | NY | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
ID Information
| ID | Type | State | Issuer | Description | 00968685 | 05 | NY | MEDICAID |