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General NPI Number Information
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NPI Number | 1093709610
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Entity Type | Individual
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Provider Name | SERGINE DESROSIERS DPM
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Gender | Female
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 09/25/2013
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Provider Practice Location Address
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Address Line | 613 THROOP AVE
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City | BROOKLYN
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State | NY
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Zip | 11216-2522
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Country | US
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Telephone | 718-602-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 445 LENOX RD BOX1262
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City | BROOKLYN
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State | NY
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Zip | 11203-2017
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Country | US
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Telephone | 718-602-6200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | N005664-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | MD002675
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | SC005652
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License Number State | PA
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