# DEROSA FACIAL PLASTIC SURGERY PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DeRosa Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164867479
- **Authorized official:** DR. JAIMIE DEROSA MD (PRESIDENT)
- **Authorized official phone:** (617) 262-8000

## Contact information

- **Practice address:** 91 NEWBURY ST, SUITE 300, BOSTON, MA 02116-3084
- **Practice address phone:** (617) 262-8000
- **Practice address fax:** (617) 262-8002
- **Mailing address:** 91 NEWBURY ST, SUITE 300, BOSTON, MA 02116-3084
- **Mailing address phone:** (617) 262-8000
- **Mailing address fax:** (617) 262-8002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YX0007X | Plastic Surgery within the Head & Neck (Otolaryngology) Physician | 237016 | MA | Yes |

## Other

- **Enumeration date:** 05/01/2013
- **Last updated:** 10/15/2014