National Provider Identifier Database

DEROSA FACIAL PLASTIC SURGERY PC
Plastic Surgery within the Head & Neck

An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them.


Contact Information

DEROSA FACIAL PLASTIC SURGERY PC
91 NEWBURY ST
SUITE 300
BOSTON, MA02116-3084
Phone: 617-262-8000
Fax: 617-262-8002
Website:
Specialty Taxonomy Code
* Plastic Surgery within the Head & Neck 207YX0007X

* Indicates primary specialty

NPI Profile & details for DEROSA FACIAL PLASTIC SURGERY PC

NPI Number 1164867479
Legal business name
LBN
DEROSA FACIAL PLASTIC SURGERY PC
Authorized official JAIMIE DEROSA - (PRESIDENT)
Entity Organization
Organization subpart No
Enumeration date 05/01/2013
Last updated 10/15/2014 - About 12 years ago
Sole proprietor1 Not specified
Identifiers
  • MA License #: 237016
  • Other: 0032529 MEDICARE GROUP PTAN
  • Other: 000755302 MEDICARE PROVIDER PTAN

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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