Healthcare Provider Details

I. General information

NPI: 1508045667
Provider Name (Legal Business Name): ACHILLES PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

384 WILSON ST
MANCHESTER NH
03103-4912
US

IV. Provider business mailing address

384 WILSON ST
MANCHESTER NH
03103-4912
US

V. Phone/Fax

Practice location:
  • Phone: 603-641-8637
  • Fax: 603-641-2143
Mailing address:
  • Phone: 603-641-8637
  • Fax: 603-641-2143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number159
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier30363701
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer

VIII. Authorized Official

Name: DR. STEVEN A ROTHSTEIN
Title or Position: MEMBER
Credential: DPM
Phone: 603-641-8637