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General NPI Number Information
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NPI Number | 1225393135
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Entity Type | Individual
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Provider Name | MRS. ELIZABETH DESGROTTES
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Gender | Female
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Dates
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Enumeration Date | 07/06/2012
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Last Update Date | 07/06/2012
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Provider Practice Location Address
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Address Line | 236 2ND AVE
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City | NEW YORK
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State | NY
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Zip | 10003-2704
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Country | US
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Telephone | 212-683-8905
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Fax |
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Provider Business Mailing Address
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Address Line | 14252 231ST ST
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City | LAURELTON
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State | NY
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Zip | 11413-3626
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Country | US
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Telephone | 646-247-6207
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 624103122
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License Number State | NY
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