Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 1817471 | NY |
NPI | 1053327338 |
---|---|
Provider Name | Joseph M Larosa |
First Address | Schenectady, NY 12308-1009 |
Second Address | Schenectady, NY 12308-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 30/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01305297 | (05) | NY |