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General NPI Number Information
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NPI Number | 1245439215
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Entity Type | Organization
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Legal Business Name | DEROSA ORTHOPEDIC SERVICES, PC
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 4701 QUEENS BLVD
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City | SUNNYSIDE
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State | NY
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Zip | 11104-1600
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Country | US
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Telephone | 718-784-4747
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 STEWART AVE
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City | GARDEN CITY
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State | NY
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Zip | 11530-4892
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Country | US
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Telephone | 718-204-0414
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Fax |
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. PATRICK DEROSA
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Credential |
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Telephone | 718-204-0414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 129321
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License Number State | NY
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