Provider Demographics
NPI:1730418492
Name:DR FRANK V DEROSA PC
Entity type:Organization
Organization Name:DR FRANK V DEROSA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-641-7700
Mailing Address - Street 1:101-11 101ST AVENUE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-9998
Mailing Address - Country:US
Mailing Address - Phone:718-641-7700
Mailing Address - Fax:718-323-1174
Practice Address - Street 1:10111 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2612
Practice Address - Country:US
Practice Address - Phone:718-641-7700
Practice Address - Fax:718-323-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003072-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty