Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 274678 | NY |
Y | 2086S0127X | Trauma Surgeon | 274678 | NY |
NPI | 1356587653 |
---|---|
Provider Name | Dr. Andrew Joseph Deroo |
First Address | Albany, NY 12208 |
Second Address | Albany, NY 12208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2008 |
Last Update Date | 17/12/2015 |