Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 006696 | NY |
Y | 222Z00000X | Podiatrist | 006696 | NY |
N | 213ES0131X | Foot Surgery | 006696 | NY |
NPI | 1093943235 |
---|---|
Provider Name | Dr. Willis Anthony Rosena |
First Address | North Tonawanda, NY 14120-4444 |
Second Address | North Tonawanda, NY 14120-4444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 16/04/2015 |