Provider Demographics
NPI:1669630943
Name:ROSELYN WROBLEWSKI
Entity Type:Organization
Organization Name:ROSELYN WROBLEWSKI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODITRIST
Authorized Official - Prefix:
Authorized Official - First Name:ROSELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WROBLEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:212-724-2622
Mailing Address - Street 1:285 WEST END AVE
Mailing Address - Street 2:2Y
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2618
Mailing Address - Country:US
Mailing Address - Phone:212-724-2622
Mailing Address - Fax:212-362-9896
Practice Address - Street 1:285 WEST END AVE
Practice Address - Street 2:2Y
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2618
Practice Address - Country:US
Practice Address - Phone:212-724-2622
Practice Address - Fax:212-362-9896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005426332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01826695Medicaid
NYPA1692Medicare PIN
NYU69950Medicare UPIN
NYPA1691Medicare PIN