Individual
DR. CHARLES A LA ROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15 PARK AVE, BAY SHORE, NY 11706-7381
(631) 581-4400
(631) 277-3750
Mailing address
15 PARK AVE, BAY SHORE, NY 11706-7381
(631) 581-4400
(631) 277-3750
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
167344
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01480831
—
NY
01
—
167344
LICENSE
NY
Enumeration date
07/07/2006
Last updated
12/01/2009
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