Organization
ROSELLE PODIATRY GROUP, PA
Active
Organization
ROSELLE PODIATRY GROUP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YEON SHIM DPM (PRESIDENT)
(908) 620-3200
Entity
Organization
Contact information
Practice address
776 E 3RD AVE, ROSELLE, NJ 07203-1698
(908) 620-3200
(908) 620-1040
Mailing address
776 E 3RD AVE, ROSELLE, NJ 07203-1698
(908) 620-3200
(908) 620-1040
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
MD002426
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4702770001
MEDICARE DME
NJ
Enumeration date
03/04/2010
Last updated
10/16/2014
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