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DEROSA CLINIC
NPI 1164867479
Otolaryngology - Plastic Surgery within the Head & Neck in Boston, MA

Active since May 01, 2013
91 NEWBURY ST, SUITE 300, BOSTON, MA 02116(617) 262-8000(617) 262-8002 Get Directions Write a Review

NPPES record last updated: October 15, 2014. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Derosa Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DEROSA CLINIC (NPI 1164867479) is a healthcare organization registered as a plastic surgery within the head & neck in Boston, Massachusetts and active in the NPI registry since May 2013. The organization lists Jaimie Derosa, President, as its authorized official.

NPPES Registry Identity

NPI1164867479
Entity TypeOrganization
Primary Taxonomy207YX0007X
Legal Business NameDEROSA FACIAL PLASTIC SURGERY PC
Location Address91 NEWBURY ST, SUITE 300Boston, MA 02116-3084
Mailing Address91 Newbury St, Suite 300Boston, MA 02116-3084 · (617) 262-8000 · Fax (617) 262-8002
Phone(617) 262-8000
Fax(617) 262-8002
Organization SubpartNo
Authorized OfficialJaimie DerosaPresident · (617) 262-8000
Enumeration DateMay 1, 2013
Last NPPES UpdateOctober 15, 2014
✔ NPI 1164867479 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOtolaryngology · Plastic Surgery within the Head & NeckAllopathic & Osteopathic Physicians
Taxonomy Code207YX0007X
License✔ Licensed in MA · 237016
Definition
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.
91 NEWBURY ST, Boston, MA 02116
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Other Names 1

Doing Business AsDerosa Clinic

Other Identifiers 2

Other000755302Medicare Provider Ptan
Other0032529Medicare Group Ptan

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JAIMIE DEROSA M.D.
Otolaryngology (Facial Plastic Surgery)
91 NEWBURY ST, SUITE 300
BOSTON, MA 02116
Suffolk County (617) 262-8000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Derosa Facial Plastic Surgery PC's NPI number?

The NPI number for Derosa Facial Plastic Surgery PC is 1164867479. It was assigned to this organization in the NPPES registry on May 1, 2013. The provider is doing business as Derosa Clinic.

Where is Derosa Facial Plastic Surgery PC located?

Derosa Facial Plastic Surgery PC is located at 91 Newbury St Suite 300, Boston, MA 02116. The listed phone number is (617) 262-8000.

What is Derosa Facial Plastic Surgery PC's specialty?

The primary specialty registered for this NPI is Otolaryngology, specializing in Plastic Surgery within the Head & Neck, with taxonomy code 207YX0007X.

When was this NPI record last updated?

The NPPES record for Derosa Facial Plastic Surgery PC was last updated on October 15, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.