Provider Demographics
NPI:1326341975
Name:DEROSSI, JOHN F (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:DEROSSI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:BOX 315
Mailing Address - Street 2:18 MARION HOUSE DR
Mailing Address - City:BOLTON LANDING
Mailing Address - State:NY
Mailing Address - Zip Code:12814
Mailing Address - Country:US
Mailing Address - Phone:518-668-9080
Mailing Address - Fax:518-668-2705
Practice Address - Street 1:18 MARION HOUSE DR
Practice Address - Street 2:
Practice Address - City:BOLTON LANDING
Practice Address - State:NY
Practice Address - Zip Code:12814
Practice Address - Country:US
Practice Address - Phone:518-668-9080
Practice Address - Fax:518-668-2705
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2010-12-20
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Provider Licenses
StateLicense IDTaxonomies
NY135664-1208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAD8333611OtherBNDD