Healthcare Provider Details

I. General information

NPI: 1366944340
Provider Name (Legal Business Name): JASON DELAROSA VIRAY RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E 23RD ST RM 13090S
NEW YORK NY
10010-5011
US

IV. Provider business mailing address

423 E 23RD ST RM 13090S
NEW YORK NY
10010-5011
US

V. Phone/Fax

Practice location:
  • Phone: 212-686-7500
  • Fax:
Mailing address:
  • Phone: 212-686-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number005351
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: