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General NPI Number Information
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NPI Number | 1609984053
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Entity Type | Organization
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Legal Business Name | JAMES B ROUSH
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Dates
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Enumeration Date | 08/27/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 186 VILLAGE SQ
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City | PAINTED POST
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State | NY
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Zip | 14870-1320
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Country | US
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Telephone | 607-936-9985
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Fax | 607-936-9991
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Provider Business Mailing Address
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Address Line | 111 E 14TH ST
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City | ELMIRA HEIGHTS
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State | NY
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Zip | 14903-1303
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Country | US
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Telephone | 607-734-9539
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Fax | 607-734-6293
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Authorized Official
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Title or Position | OWNER
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Name | JAMES B ROUSH
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Credential | D.P.M.
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Telephone | 607-936-9985
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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 |
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License Number State |
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