Provider Demographics
NPI:1902065485
Name:NASSAU PODIATRIC SURGICAL OFFICES, PC
Entity Type:Organization
Organization Name:NASSAU PODIATRIC SURGICAL OFFICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTWEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:516-481-7414
Mailing Address - Street 1:33 FRONT ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3601
Mailing Address - Country:US
Mailing Address - Phone:516-481-7414
Mailing Address - Fax:516-481-5115
Practice Address - Street 1:33 FRONT ST
Practice Address - Street 2:SUITE 306
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3601
Practice Address - Country:US
Practice Address - Phone:516-481-7414
Practice Address - Fax:516-481-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002821261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric