Provider Demographics
NPI:1043675630
Name:DR WILL A ROSENA DPM
Entity Type:Organization
Organization Name:DR WILL A ROSENA DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:WILL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSENA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:716-692-1451
Mailing Address - Street 1:87 MEAD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-4444
Mailing Address - Country:US
Mailing Address - Phone:716-692-1451
Mailing Address - Fax:716-692-1495
Practice Address - Street 1:87 MEAD ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-4444
Practice Address - Country:US
Practice Address - Phone:716-692-1451
Practice Address - Fax:716-692-1495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty