Provider Demographics
NPI:1174631519
Name:ROUSH, JAMES B (DPM)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:B
Last Name:ROUSH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:186 VILLAGE SQ
Mailing Address - Street 2:
Mailing Address - City:PAINTED POST
Mailing Address - State:NY
Mailing Address - Zip Code:14870-1320
Mailing Address - Country:US
Mailing Address - Phone:607-936-9985
Mailing Address - Fax:607-936-9991
Practice Address - Street 1:186 VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-1320
Practice Address - Country:US
Practice Address - Phone:607-936-9985
Practice Address - Fax:607-936-9991
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN004965213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01345344Medicaid
NY56603BMedicare ID - Type Unspecified
NYU32136Medicare UPIN