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General NPI Number Information
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NPI Number | 1588811665
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Entity Type | Organization
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Legal Business Name | JEAN ROBERT DESROULEAUX MD,PC
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 175 FULTON AVE SUITE 208
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City | HEMPSTEAD
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State | NY
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Zip | 11550-3718
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Country | US
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Telephone | 516-292-7443
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Fax | 516-483-7847
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Provider Business Mailing Address
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Address Line | 10 GRACE LANE
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City | OYSTER BAY
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State | NY
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Zip | 11771-4020
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Country | US
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Telephone | 516-292-7443
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Fax | 516-483-7847
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEAN-ROBERT DESROULEAUX
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Credential | M.D.
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Telephone | 516-292-7443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 181744
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License Number State | NY
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