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General NPI Number Information
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NPI Number | 1093943235
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Entity Type | Individual
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Provider Name | WILLIS ANTHONY ROSENA D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/25/2009
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Last Update Date | 04/16/2015
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Provider Practice Location Address
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Address Line | 87 MEAD ST
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-4444
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Country | US
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Telephone | 716-692-1451
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Fax | 716-692-1495
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Provider Business Mailing Address
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Address Line | 87 MEAD ST
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-4444
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Country | US
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Telephone | 716-692-1451
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Fax | 716-692-1495
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 006696
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 006696
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License Number State | NY
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