Provider Demographics
NPI:1780758946
Name:DEROSA, DONNA M (DC)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:DEROSA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 MORRIS PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462
Mailing Address - Country:US
Mailing Address - Phone:718-863-0777
Mailing Address - Fax:718-904-8044
Practice Address - Street 1:997 MORRIS PARK AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462
Practice Address - Country:US
Practice Address - Phone:718-863-0777
Practice Address - Fax:718-904-8044
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006386111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U10294Medicare UPIN
NYX46181Medicare PIN