Active NPI
Vincent A Derosa, M.D.
- Ophthalmology Physician
- Jamestown, NY
National Provider Identifier
1629395496
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 116552
- Practice address
- 2652 Widdy Bostwick Lane
Jamestown, NY 14701-9111 - Phone
- (716) 483-0355
- NPI assigned
- May 3, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 116552 | NY | Primary |
Addresses
Primary practice location
2652 Widdy Bostwick Lane
Jamestown, NY 14701-9111
Mailing address
2652 Widdy Bostick Rd
Jamestown, NY 14701-9111
Phone (716) 483-0355
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 116552 | NY | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1272844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272844800000",
"number": "1629395496",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2652 WIDDY BOSTICK RD",
"city": "JAMESTOWN",
"state": "NY",
"postal_code": "147019111",
"telephone_number": "716-483-0355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2652 WIDDY BOSTWICK LANE",
"city": "JAMESTOWN",
"state": "NY",
"postal_code": "147019111",
"telephone_number": "716-483-0355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEROSA",
"first_name": "VINCENT",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-05-03",
"last_updated": "2010-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NY",
"license": "116552",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jamestown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.