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1366867335 NPI number — PATRICK J. DEROSA MD LONG ISLAND SPORTS AND ORTHOPEDIC THERAPY CENTER

NPI Number: 1366867335
Health Care Provider/Practitioner: PATRICK J. DEROSA MD LONG ISLAND SPORTS AND ORTHOPEDIC THERAPY CENTER

Information about “1366867335” NPI (PATRICK J. DEROSA MD LONG ISLAND SPORTS AND ORTHOPEDIC THERAPY CENTER) exists in 1366867335 in HTML format HTML  |  1366867335 in plain Text format TXT  |  1366867335 in PDF (Portable Document Format) PDF  |  1366867335 in an XML format XML  formats.

NPI Number : 1366867335 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366867335",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PATRICK J. DEROSA MD LONG ISLAND SPORTS AND ORTHOPEDIC THERAPY CENTER",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "825 E GATE BLVD",
    "SecondLineMailingAddress": "SUITE 100",
    "MailingAddressCityName": "GARDEN CITY",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11530-2124",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "516-227-5344",
    "MailingAddressFaxNumber": "516-227-5339",
    "FirstLinePracticeLocationAddress": "825 E GATE BLVD",
    "SecondLinePracticeLocationAddress": "SUITE 100",
    "PracticeLocationAddressCityName": "GARDEN CITY",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11530-2124",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "516-227-5344",
    "PracticeLocationAddressFaxNumber": "516-227-5339",
    "EnumerationDate": "02/26/2014",
    "LastUpdateDate": "08/07/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DEROSA",
    "AuthorizedOfficialFirstName": "PATRICK",
    "AuthorizedOfficialMiddleName": "J.",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "516-227-5344",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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