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General NPI Number Information
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NPI Number | 1366867335
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Entity Type | Organization
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Legal Business Name | PATRICK J. DEROSA MD LONG ISLAND SPORTS AND ORTHOPEDIC THERAPY CENTER
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Dates
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Enumeration Date | 02/26/2014
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 825 E GATE BLVD SUITE 100
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City | GARDEN CITY
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State | NY
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Zip | 11530-2124
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Country | US
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Telephone | 516-227-5344
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Fax | 516-227-5339
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Provider Business Mailing Address
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Address Line | 825 E GATE BLVD SUITE 100
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City | GARDEN CITY
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State | NY
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Zip | 11530-2124
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Country | US
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Telephone | 516-227-5344
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Fax | 516-227-5339
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PATRICK J. DEROSA
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Credential | MD
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Telephone | 516-227-5344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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