Provider Demographics
NPI:1942461157
Name:ROSERO, ELVIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELVIS
Middle Name:
Last Name:ROSERO
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 1:1076 PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3002
Mailing Address - Country:US
Mailing Address - Phone:917-239-5169
Mailing Address - Fax:
Practice Address - Street 1:1076 PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3002
Practice Address - Country:US
Practice Address - Phone:917-239-5169
Practice Address - Fax:609-883-6160
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00350300213ES0103X
NYN006317213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery