| Organization Name: | PATRICK J. DEROSA MD LONG ISLAND SPORTS AND ORTHOPEDIC THERAPY CENTER |
| NPI Number: | 1366867335 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PATRICK J. DEROSA (PRESIDENT) |
| Mailing Address: | 825 E Gate Blvd Suite 100 Garden City |
| State: | NY US |
| Postal Code: | 115302124 |
| Phone Number: | 5162275344 |
| Fax Number: | 5162275339 |
| NPI Enumeration Date: | 02/26/2014 |
| NPI Last Update Date: | 08/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |