Roselle Podiatry Group, PA

Primary specialty

Foot Surgery PodiatristTaxonomy code 213ES0131X

License

MD002426 Issued in NJ

Legal business name

ROSELLE PODIATRY GROUP, PA

Practice address

776 E 3Rd Ave
Roselle, NJ 07203-1698

Phone

(908) 620-3200

Fax

(908) 620-1040

NPI assigned

Mar 4, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yeon Shim, DPMNPI 1679504302

Title

President

Phone

(908) 620-3200

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ2 enrollments

Enrollment records 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Yeon A Shim, DPM

  • Foot Surgery Podiatrist
  • Roselle, NJ
  • NPI 1679504302
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1267660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413417600000",
    "number": "1003139031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "776 E 3RD AVE",
            "city": "ROSELLE",
            "state": "NJ",
            "postal_code": "072031698",
            "telephone_number": "908-620-3200",
            "fax_number": "908-620-1040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "776 E 3RD AVE",
            "city": "ROSELLE",
            "state": "NJ",
            "postal_code": "072031698",
            "telephone_number": "908-620-3200",
            "fax_number": "908-620-1040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSELLE PODIATRY GROUP, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-04",
        "last_updated": "2014-10-16",
        "status": "A",
        "authorized_official_last_name": "SHIM",
        "authorized_official_first_name": "YEON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "908-620-3200",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "NJ",
            "license": "MD002426",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME",
            "identifier": "4702770001",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Naomi Rodas
• Jason Rosa, LCSW
• Roselle Board of Education
• Roselle Center Rita Pharmacy
• Roselle Commons Dental Center, PC
• Louis Paul Ruales, PHARM D
• Nicole Sylvia Sai
• Eric Saltisky, PHARMD
• Ruby Saluja, MD
• Jazmine Blair Sandifer-Charles

• Foot Surgery Podiatrist in Roselle, NJ
• Providers in Roselle, NJ by specialty
• Foot Surgery Podiatrist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.