Provider Demographics
NPI:1174846406
Name:BRONX PODIATRY ASSOCIATES LLC
Entity Type:Organization
Organization Name:BRONX PODIATRY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ROSENBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-792-5900
Mailing Address - Street 1:820 LYDIG AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2106
Mailing Address - Country:US
Mailing Address - Phone:718-792-5900
Mailing Address - Fax:718-931-9324
Practice Address - Street 1:820 LYDIG AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-2106
Practice Address - Country:US
Practice Address - Phone:718-792-5900
Practice Address - Fax:718-931-9324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005978332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
V04167Medicare UPIN