Provider Demographics
NPI:1689771685
Name:AFFILIATED PODIATRISTS, INC
Entity Type:Organization
Organization Name:AFFILIATED PODIATRISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:ROSENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-946-5858
Mailing Address - Street 1:7230 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-7522
Mailing Address - Country:US
Mailing Address - Phone:440-946-5858
Mailing Address - Fax:440-918-4870
Practice Address - Street 1:7230 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-7522
Practice Address - Country:US
Practice Address - Phone:440-946-5858
Practice Address - Fax:440-918-4870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-001751213EP0504X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic MedicineGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0368909Medicaid
OH9209751Medicare PIN
OH1034800001Medicare NSC
OH0368909Medicaid