| Organization Name: | ROSELLE PODIATRY GROUP, PA |
| NPI Number: | 1003139031 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | YEON SHIM (PRESIDENT) |
| Mailing Address: | 776 E 3rd Ave Roselle |
| State: | NJ US |
| Postal Code: | 072031698 |
| Phone Number: | 9086203200 |
| Fax Number: | 9086201040 |
| NPI Enumeration Date: | 03/04/2010 |
| NPI Last Update Date: | 10/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | MD002426 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |