Provider Demographics
NPI:1205852225
Name:ROSSI, JENNIFER ANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:ROSSI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7612 DRESDEN AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-2804
Mailing Address - Country:US
Mailing Address - Phone:440-759-0672
Mailing Address - Fax:440-884-7661
Practice Address - Street 1:7612 DRESDEN AVE
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-2804
Practice Address - Country:US
Practice Address - Phone:440-759-0672
Practice Address - Fax:440-884-7661
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003376213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2528232Medicaid
OH4144061Medicare ID - Type Unspecified
OH2528232Medicaid