Provider Demographics
NPI:1346241510
Name:ROSENTHAL, ALLAN I (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:I
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PROSPECT ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4514
Mailing Address - Country:US
Mailing Address - Phone:203-431-0048
Mailing Address - Fax:203-431-6328
Practice Address - Street 1:30 PROSPECT ST
Practice Address - Street 2:SUITE 400
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4514
Practice Address - Country:US
Practice Address - Phone:203-431-0048
Practice Address - Fax:203-431-6328
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT164213E00000X, 213ES0000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010164OtherCONNECTICARE
CT041251OtherHEALTHNET
CT030000164CT01OtherANTHEM
CT4006334Medicaid
NY13098OtherGHI
CT030000164CT01OtherANTHEM
CTT22823Medicare UPIN