Basic Information
| Provider Information | |||||||||
| NPI: | 1669923793 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DEROSA | ||||||||
| FirstName: | KARA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 766 CURTIS AVE | ||||||||
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| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103102611 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 423 E 23RD ST | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100105011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126867500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2016 | ||||||||
| LastUpdateDate: | 10/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 020297 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.