Provider Demographics
NPI:1306180187
Name:FABIENNE ROTTENBERG
Entity Type:Organization
Organization Name:FABIENNE ROTTENBERG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FABIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-724-4457
Mailing Address - Street 1:285 WEST END AVE.
Mailing Address - Street 2:4YW
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2618
Mailing Address - Country:US
Mailing Address - Phone:212-724-4457
Mailing Address - Fax:212-362-9896
Practice Address - Street 1:285 WEST END AVE.
Practice Address - Street 2:4Y
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2618
Practice Address - Country:US
Practice Address - Phone:212-724-4457
Practice Address - Fax:212-362-9896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01076360Medicaid
NYP45811Medicare UPIN
NY01076360Medicaid