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NPI Code Detail

MEDICARE: DR. WILLIS ANTHONY ROSENA D.P.M.

MEDICARE: DR. WILLIS ANTHONY ROSENA D.P.M.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatrist006696NY
2213ES0131XFoot Surgery Podiatrist006696NY

General Provider Information

NPI Number : 1093943235
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIS ANTHONY ROSENA D.P.M.
Provider Business Mailing Address
First Line : 87 MEAD ST
Second Line :
City : NORTH TONAWANDA
State : NY
Zip : 14120-4444
Country : US
Telephone Number : 716-692-1451
Fax Number : 716-692-1495
Provider Business Practice Location Address
First Line : 87 MEAD ST
Second Line :
City : NORTH TONAWANDA
State : NY
Zip : 14120-4444
Country : US
Telephone Number : 716-692-1451
Fax Number : 716-692-1495
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2009
Last Update Date : 04/16/2015

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