Provider Demographics
NPI:1093943235
Name:ROSENA, WILLIS ANTHONY (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIS
Middle Name:ANTHONY
Last Name:ROSENA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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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
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY006696213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery