Provider Demographics
NPI:1407028970
Name:ALLAN I. ROSENTHAL DPM
Entity Type:Organization
Organization Name:ALLAN I. ROSENTHAL DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:I
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-431-0048
Mailing Address - Street 1:30 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4562
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:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4562
Practice Address - Country:US
Practice Address - Phone:203-431-0048
Practice Address - Fax:203-431-6328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000164213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0275120001Medicare NSC