Healthcare Provider Details

I. General information

NPI: 1083698963
Provider Name (Legal Business Name): ROGER ADAM HANS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2005
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3116 30TH AVE SUITE#203
ASTORIA NY
11102-1545
US

IV. Provider business mailing address

3116 30TH AVE SUITE#203
ASTORIA NY
11102-1545
US

V. Phone/Fax

Practice location:
  • Phone: 718-545-3338
  • Fax: 718-626-3034
Mailing address:
  • Phone: 718-545-3338
  • Fax: 718-626-3034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN004560
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: