Provider Demographics
NPI:1992714026
Name:ROTTENBERG, FABIENNE (DPM)
Entity type:Individual
Prefix:
First Name:FABIENNE
Middle Name:
Last Name:ROTTENBERG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 WEST END AVENUE
Mailing Address - Street 2:SUITE 4Y
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2618
Mailing Address - Country:US
Mailing Address - Phone:212-724-4457
Mailing Address - Fax:
Practice Address - Street 1:285 WEST END AVENUE
Practice Address - Street 2:SUITE 4Y
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2618
Practice Address - Country:US
Practice Address - Phone:212-724-4457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004131-1213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T51463Medicare PIN
NY1160570001Medicare NSC