Provider Demographics
NPI:1285875773
Name:TODD ROTWEIN DPM PC
Entity type:Organization
Organization Name:TODD ROTWEIN DPM 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:2009-03-13
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002821213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00414062Medicaid
NYA100000963Medicare PIN
NY00414062Medicaid