Provider Demographics
NPI:1568401230
Name:LAROSA, PAUL GEORGE (MS, PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:GEORGE
Last Name:LAROSA
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Gender:M
Credentials:MS, PT
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Mailing Address - Street 1:133 E 58TH ST
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1236
Mailing Address - Country:US
Mailing Address - Phone:212-355-4481
Mailing Address - Fax:212-355-4489
Practice Address - Street 1:133 E 58TH ST
Practice Address - Street 2:SUITE 1001
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1236
Practice Address - Country:US
Practice Address - Phone:212-355-4481
Practice Address - Fax:212-355-4489
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY016429-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQQ4611Medicare PIN