Provider Demographics
NPI:1033116413
Name:ROTWEIN, TODD (DPM)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:ROTWEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 FRONT ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3601
Mailing Address - Country:US
Mailing Address - Phone:516-481-7414
Mailing Address - Fax:516-481-5115
Practice Address - Street 1:33 FRONT ST
Practice Address - Street 2:SUITE 306
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3601
Practice Address - Country:US
Practice Address - Phone:516-481-7414
Practice Address - Fax:516-481-5115
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002821213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00414062Medicaid
T50894Medicare UPIN
NY4972050001Medicare NSC