Provider Demographics
NPI:1730210469
Name:ROME PODIATRY GROUP, LLP
Entity type:Organization
Organization Name:ROME PODIATRY GROUP, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:315-336-5562
Mailing Address - Street 1:321 W THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-4149
Mailing Address - Country:US
Mailing Address - Phone:315-336-5562
Mailing Address - Fax:315-336-6985
Practice Address - Street 1:321 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-4149
Practice Address - Country:US
Practice Address - Phone:315-336-5562
Practice Address - Fax:315-336-6985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNOO43531213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00603383Medicaid
NY00603383Medicaid