Provider Demographics
NPI:1417306671
Name:DELA ROSA, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DELA ROSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 BAY 19TH ST.
Mailing Address - Street 2:201
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214
Mailing Address - Country:US
Mailing Address - Phone:718-253-1366
Mailing Address - Fax:718-253-5890
Practice Address - Street 1:195 BAY 19TH ST STE 201
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4762
Practice Address - Country:US
Practice Address - Phone:718-253-1366
Practice Address - Fax:718-253-5890
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty