MEDICARE: REGINALD ROUSSEAU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician	228851	NY
2	208VP0014X	Interventional Pain Medicine Physician	228851	NY
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	228851	NY
4	207L00000X	Anesthesiology Physician	228851	NY
5	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	228851	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306822523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINALD ROUSSEAU MD

Provider Business Mailing Address
First Line	:	100 MOTOR PARKWAY
Second Line	:	LL8
City	:	HAUPPAUGE
State	:	NY
Zip	:	11788
Country	:	US
Telephone Number	:	833-547-7463
Fax Number	:	631-248-5583

Provider Business Practice Location Address
First Line	:	340 HOWELLS RD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5322
Country	:	US
Telephone Number	:	833-547-7463
Fax Number	:	631-248-5583

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	04/29/2024

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Directions to “ REGINALD ROUSSEAU MD” Practice Location

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