ROSELLE PODIATRY GROUP PA NPI 1003139031

NPI Information

  • NPI: 1003139031
  • Provider Name: ROSELLE PODIATRY GROUP, PA
  • Classification: Podiatrist - 213ES0131X
  • Specialization: Foot Surgery
  • Entity Type: Organization
  • Address: 776 E 3RD AVE
    ROSELLE, NJ
    ZIP 07203
  • Phone: (908) 620-3200

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NPI Details

ROSELLE PODIATRY GROUP, PA is a foot surgery podiatrist in Roselle, NJ. ROSELLE PODIATRY GROUP, PA NPI is 1003139031. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

776 E 3RD AVE
ROSELLE, NJ
ZIP 07203-698
Phone: (908) 620-3200
Fax: (908) 620-1040

The provider's authorized official is Yeon Shim .
The authorized official title is President and has the following contact phone number (908) 620-3200.

The enumeration date for this NPI number is 3/4/2010 and was last updated on 10/16/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1213ES0131XPodiatristFoot SurgeryMD002426NEW JERSEYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
14702770001MEDICARE NSC
2006323MEDICARE OSCAR/CERTIFICATIONNEW JERSEY
34702770001OTHERNEW JERSEYMEDICARE DME

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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