Healthcare Provider Details

I. General information

NPI: 1689771685
Provider Name (Legal Business Name): AFFILIATED PODIATRISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7230 MENTOR AVE
MENTOR OH
44060-7522
US

IV. Provider business mailing address

7230 MENTOR AVE
MENTOR OH
44060-7522
US

V. Phone/Fax

Practice location:
  • Phone: 440-946-5858
  • Fax: 440-918-4870
Mailing address:
  • Phone: 440-946-5858
  • Fax: 440-918-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number36-001751
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36-001751
License Number StateOH

VIII. Authorized Official

Name: DR. ROBERT JAMES ROSENSTEIN
Title or Position: PRESIDENT
Credential: DPM
Phone: 440-946-5858