Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Derosa Facial Plastic Surgery PC

Organization Plastic Surgery within the Head & Neck (Otolaryngology) Physician · NPI 1164867479

Derosa Facial Plastic Surgery PC is a Plastic Surgery within the Head & Neck (Otolaryngology) Physician in Boston, Massachusetts. Licensed in Massachusetts. Registered with an NPI since 2013.

Licensed in
MA
In the registry since
2013
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

91 Newbury St Ste 300
Boston, MA 02116-3084
Phone: (617) 262-8000
Fax: (617) 262-8002
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Plastic Surgery within the Head & Neck (Otolaryngology) Physician (primary) Taxonomy 207YX0007X · Licence 237016 (MA)

Record details

NPI number1164867479
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jaimie Derosa — President · (617) 262-8000
Other names Derosa Clinic
NPI enumeratedMay 1, 2013
Last updated in NPPESOctober 15, 2014
Mailing address91 Newbury St, Suite 300, Boston, MA 02116-3084

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