Provider Demographics
NPI:1366867335
Name:PATRICK J. DEROSA MD LONG ISLAND SPORTS AND ORTHOPEDIC THERAPY CENTER
Entity Type:Organization
Organization Name:PATRICK J. DEROSA MD LONG ISLAND SPORTS AND ORTHOPEDIC THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEROSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-227-5344
Mailing Address - Street 1:825 E GATE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2124
Mailing Address - Country:US
Mailing Address - Phone:516-227-5344
Mailing Address - Fax:516-227-5339
Practice Address - Street 1:825 E GATE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-2124
Practice Address - Country:US
Practice Address - Phone:516-227-5344
Practice Address - Fax:516-227-5339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty