Provider Demographics
NPI:1992796288
Name:LAROSA, CHRISTOPHER (PHYSICIANS ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:LAROSA
Suffix:
Gender:M
Credentials:PHYSICIANS ASSISTANT
Other - Prefix:
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Mailing Address - Street 1:585 BROADWAY
Mailing Address - Street 2:BROADWAY INTERNAL MEDICINE ASSOCIATES
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758
Mailing Address - Country:US
Mailing Address - Phone:516-797-1234
Mailing Address - Fax:516-797-0190
Practice Address - Street 1:585 BROADWAY
Practice Address - Street 2:BROADWAY INTERNAL MEDICINE ASSOCIATES
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758
Practice Address - Country:US
Practice Address - Phone:516-797-1234
Practice Address - Fax:516-797-0190
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2023-03-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYML0568076OtherDEA