=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730210469
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROME PODIATRY GROUP, LLP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 01/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 321 W THOMAS ST
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13440-4149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-336-5562
-----------------------------------------------------
Fax | 315-336-6985
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 321 W THOMAS ST
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13440-4149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-336-5562
-----------------------------------------------------
Fax | 315-336-6985
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. JOHN KOSAR
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 315-336-5562
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | NOO43531
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------