Provider Demographics
NPI:1417410770
Name:DELROSSO, MICHAEL PIETRO
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PIETRO
Last Name:DELROSSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 BROADWAY STE 2
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1743
Mailing Address - Country:US
Mailing Address - Phone:845-692-3668
Mailing Address - Fax:845-794-0228
Practice Address - Street 1:427 BROADWAY STE 2
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1743
Practice Address - Country:US
Practice Address - Phone:845-692-3668
Practice Address - Fax:845-794-0228
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007345213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist