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General NPI Number Information
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NPI Number | 1427285527
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Entity Type | Organization
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Legal Business Name | NEPHROLOGY&HYPERTENSION CONSULTANTS OF LONG ISLAND&QUEENS
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Dates
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Enumeration Date | 06/16/2009
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Last Update Date | 06/16/2009
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Provider Practice Location Address
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Address Line | 1975 LINDEN BLVD SUITE 105
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City | ELMONT
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State | NY
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Zip | 11003-4004
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Country | US
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Telephone | 516-285-2850
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Fax |
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Provider Business Mailing Address
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Address Line | 1975 LINDEN BLVD SUITE 105
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City | ELMONT
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State | NY
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Zip | 11003-4004
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Country | US
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Telephone | 516-285-2850
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. LIONEL DESROCHES
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Credential | M.D
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Telephone | 516-285-2850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F335744-1
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License Number State | NY
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