Provider Demographics
NPI:1083676654
Name:ROSENZWEIG, DAVID PETER (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PETER
Last Name:ROSENZWEIG
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 1:90 SOUTH RIDGE ST
Mailing Address - Street 2:STE LL7
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2867
Mailing Address - Country:US
Mailing Address - Phone:914-937-7077
Mailing Address - Fax:914-937-7677
Practice Address - Street 1:90 S RIDGE ST
Practice Address - Street 2:STE LL7
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-2867
Practice Address - Country:US
Practice Address - Phone:914-937-7077
Practice Address - Fax:914-937-7677
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0034311213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00763873Medicaid
NY00763873Medicaid
NY00763873Medicaid