Provider Demographics
NPI:1548795735
Name:LAROSA, ANDREA (DO)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:LAROSA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 MERRICK RD
Mailing Address - Street 2:SOUTH NASSAU FAMILY MEDICINE, ATTN: JOANNE BARKLEY
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1420
Mailing Address - Country:US
Mailing Address - Phone:516-255-8414
Mailing Address - Fax:
Practice Address - Street 1:196 MERRICK RD
Practice Address - Street 2:SOUTH NASSAU FAMILY MEDICINE, ATTN: JOANNE BARKLEY
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1420
Practice Address - Country:US
Practice Address - Phone:516-255-8414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program