MEDICARE: DR. ALLAN I. ROSENTHAL 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
1	213E00000X	Podiatrist	164	CT
2	213ES0000X	Sports Medicine Podiatrist	164	CT
3	213ES0131X	Foot Surgery Podiatrist	164	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010164	OTHER	CT	CONNECTICARE
2	041251	OTHER	CT	HEALTHNET
3	030000164CT01	OTHER	CT	ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	13098	OTHER	NY	GHI

General Provider Information

NPI Number	:	1346241510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLAN I. ROSENTHAL D.P.M.

Provider Business Mailing Address
First Line	:	30 PROSPECT ST
Second Line	:	SUITE 400
City	:	RIDGEFIELD
State	:	CT
Zip	:	06877-4514
Country	:	US
Telephone Number	:	203-431-0048
Fax Number	:	203-431-6328

Provider Business Practice Location Address
First Line	:	30 PROSPECT ST
Second Line	:	SUITE 400
City	:	RIDGEFIELD
State	:	CT
Zip	:	06877-4514
Country	:	US
Telephone Number	:	203-431-0048
Fax Number	:	203-431-6328

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	03/10/2008

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Directions to “ DR. ALLAN I. ROSENTHAL D.P.M.” Practice Location

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