=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609033448
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED PODIATRY AND FOOTCARE OBS,PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2008
-----------------------------------------------------
Last Update Date | 05/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 90 S RIDGE ST LL7
-----------------------------------------------------
City | RYE BROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10573-2867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-937-7077
-----------------------------------------------------
Fax | 914-937-7677
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 90 S RIDGE ST LL7
-----------------------------------------------------
City | RYE BROOK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10573-2867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-937-7077
-----------------------------------------------------
Fax | 914-937-7677
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID PETER ROSENZWEIG
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 914-937-7077
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | N0034311
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------