Provider Demographics
NPI:1285785147
Name:ROSAS, HOWARD (DPM)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:ROSAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:HOWARD
Other - Middle Name:
Other - Last Name:ROSAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:4960 BROADWAY
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-2314
Mailing Address - Country:US
Mailing Address - Phone:212-569-3310
Mailing Address - Fax:
Practice Address - Street 1:4960 BROADWAY
Practice Address - Street 2:SUITE 1-C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-2314
Practice Address - Country:US
Practice Address - Phone:212-569-3310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004129174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01011458Medicaid
NY0703600001Medicare NSC
NYT45016Medicare UPIN
NY01011458Medicaid