Organization
DEROSA ORTHOPEDIC SERVICES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PATRICK DEROSA (DOCTOR/OWNER)
(718) 204-0414
Entity
Organization
Contact information
Practice address
4701 QUEENS BLVD, SUNNYSIDE, NY 11104-1600
(718) 784-4747
Mailing address
1101 STEWART AVE, GARDEN CITY, NY 11530-4892
(718) 204-0414
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
129321
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00402355
—
NY
Enumeration date
07/11/2007
Last updated
12/27/2007
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