Provider Demographics
NPI:1083698963
Name:HANS, ROGER ADAM (DPM)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:ADAM
Last Name:HANS
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 1:3116 30TH AVE
Mailing Address - Street 2:SUITE#203
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1545
Mailing Address - Country:US
Mailing Address - Phone:718-545-3338
Mailing Address - Fax:718-626-3034
Practice Address - Street 1:3116 30TH AVE
Practice Address - Street 2:SUITE#203
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1545
Practice Address - Country:US
Practice Address - Phone:718-545-3338
Practice Address - Fax:718-626-3034
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-03
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004560213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU35604Medicare UPIN
NY01309Medicare PIN