MEDICARE: THOMAS J LAROSA D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X004723	NY

General Provider Information

NPI Number	:	1609952399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS J LAROSA D.C.

Provider Business Mailing Address
First Line	:	PO BOX 1272
Second Line	:
City	:	PINE BUSH
State	:	NY
Zip	:	12566-1272
Country	:	US
Telephone Number	:	845-744-2244
Fax Number	:	845-744-6153

Provider Business Practice Location Address
First Line	:	76 BONIFACE DR STE 2
Second Line	:
City	:	PINE BUSH
State	:	NY
Zip	:	12566-4611
Country	:	US
Telephone Number	:	845-744-2244
Fax Number	:	845-744-6153

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	08/19/2022

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