NPIMap

Organization Active NPI

Derosa Facial Plastic Surgery PC

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Boston, MA
National Provider Identifier
1164867479
Registry record updated Oct 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X
License
237016 Issued in MA
Legal business name
DEROSA FACIAL PLASTIC SURGERY PC
Practice address
91 Newbury St
Suite 300
Boston, MA 02116-3084
Phone
(617) 262-8000
Fax
(617) 262-8002
NPI assigned
May 1, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jaimie Derosa, MD
Title
President
Phone
(617) 262-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207YX0007X 237016 MA Primary

Addresses

Primary practice location

91 Newbury St
Suite 300
Boston, MA 02116-3084

Mailing address

91 Newbury St
Suite 300
Boston, MA 02116-3084
Phone (617) 262-8000

Other identifiers 2

IdentifierTypeStateIssuer
0032529OtherMEDICARE GROUP PTAN
000755302OtherMEDICARE PROVIDER PTAN

Other names 1

  • DeRosa Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

91 Newbury St
Ste 300
Boston, MA 02116
Phone (617) 262-8000

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413331200000",
    "number": "1164867479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91 NEWBURY ST",
            "address_2": "SUITE 300",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021163084",
            "telephone_number": "617-262-8000",
            "fax_number": "617-262-8002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 NEWBURY ST",
            "address_2": "SUITE 300",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021163084",
            "telephone_number": "617-262-8000",
            "fax_number": "617-262-8002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEROSA FACIAL PLASTIC SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-01",
        "last_updated": "2014-10-15",
        "status": "A",
        "authorized_official_last_name": "DEROSA",
        "authorized_official_first_name": "JAIMIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-262-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207YX0007X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "MA",
            "license": "237016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "0032529",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER PTAN",
            "identifier": "000755302",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DeRosa Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boston, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.