Healthcare Provider Details

I. General information

NPI: 1003928987
Provider Name (Legal Business Name): LIONEL EMANUEL DESROCHES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22414 MERRICK BLVD
LAURELTON NY
11413-2023
US

IV. Provider business mailing address

1975 LINDEN BLVD SUITE 105
ELMONT NY
11003-4025
US

V. Phone/Fax

Practice location:
  • Phone: 718-949-6433
  • Fax: 718-949-0331
Mailing address:
  • Phone: 516-285-2850
  • Fax: 516-285-0038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number172523
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number172523
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: