Provider Demographics
NPI:1821390048
Name:THOMAS J. LAROSA DC PC
Entity Type:Organization
Organization Name:THOMAS J. LAROSA DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-744-2244
Mailing Address - Street 1:PO BOX 1272
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-1272
Mailing Address - Country:US
Mailing Address - Phone:845-744-2244
Mailing Address - Fax:845-744-6153
Practice Address - Street 1:76 BONIFACE DR STE 2
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566-4611
Practice Address - Country:US
Practice Address - Phone:845-744-2244
Practice Address - Fax:845-744-6153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX04723-1261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty