Provider Demographics
NPI:1497422034
Name:DERASMO, FRANCIS M
Entity Type:Individual
Prefix:MR
First Name:FRANCIS
Middle Name:M
Last Name:DERASMO
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 1:347 HOLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-1871
Mailing Address - Country:US
Mailing Address - Phone:163-156-1126
Mailing Address - Fax:
Practice Address - Street 1:347 HOLBROOK RD
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-1871
Practice Address - Country:US
Practice Address - Phone:163-156-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006980-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist