Provider Demographics
NPI:1013377548
Name:ROSENZWEIG, SAMANTHA (DPM)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ROSENZWEIG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:DELREGNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:466 OLD HOOK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1368
Mailing Address - Country:US
Mailing Address - Phone:201-967-8221
Mailing Address - Fax:
Practice Address - Street 1:466 OLD HOOK RD STE 1
Practice Address - Street 2:
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1368
Practice Address - Country:US
Practice Address - Phone:201-967-8221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006751213E00000X
NJ25MD00327400213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist