Provider Demographics
NPI:1760410153
Name:ROSSI, PETER F (DPM)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:F
Last Name:ROSSI
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 1:70 W 32ND ST
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-2850
Mailing Address - Country:US
Mailing Address - Phone:973-616-7117
Mailing Address - Fax:973-616-7338
Practice Address - Street 1:70 W 32ND ST
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-2850
Practice Address - Country:US
Practice Address - Phone:973-616-7117
Practice Address - Fax:973-616-7338
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01371213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1609301Medicaid
NJ9073302Medicaid
NJ057112Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
NJ1609301Medicaid
NJ485089QH7Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE