# MICHAEL DEROSA NP ADULT HEALTH PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831817824
- **Authorized official:** MICHAEL DEROSA NP (PRESIDENT)
- **Authorized official phone:** (516) 983-3452

## Contact information

- **Practice address:** 314 E MAIN ST, SMITHTOWN, NY 11787-2901
- **Practice address phone:** (516) 983-3452
- **Mailing address:** 4 BRASSWOOD RD, SAINT JAMES, NY 11780-3410

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 08/16/2022
- **Last updated:** 08/16/2022