MEDICARE: THOMAS J. LAROSA DC PC

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	261QM2500X	Medical Specialty Clinic/Center	X04723-1	NY

General Provider Information

NPI Number	:	1821390048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS J. LAROSA DC PC

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	:	DIRECTOR
Name	:	THOMAS J LAROSA
Credential	:	DC
Telephone Number	:	845-744-2244

Provider Enumeration Date	:	11/19/2010
Last Update Date	:	08/17/2022

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