Healthcare Provider Details

I. General information

NPI: 1609984053
Provider Name (Legal Business Name): JAMES B ROUSH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 VILLAGE SQ
PAINTED POST NY
14870-1320
US

IV. Provider business mailing address

111 E 14TH ST
ELMIRA HEIGHTS NY
14903-1303
US

V. Phone/Fax

Practice location:
  • Phone: 607-936-9985
  • Fax: 607-936-9991
Mailing address:
  • Phone: 607-734-9539
  • Fax: 607-734-6293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: JAMES B ROUSH
Title or Position: OWNER
Credential: D.P.M.
Phone: 607-936-9985