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General NPI Number Information
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NPI Number | 1831329135
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Entity Type | Individual
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Provider Name | ROOLS DESLOUCHES N.P.,
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Gender | Male
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | 820 SUFFOLK AVE
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City | BRENTWOOD
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State | NY
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Zip | 11717-4498
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Country | US
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Telephone | 631-947-0030
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Fax | 631-947-7888
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Provider Business Mailing Address
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Address Line | 820 SUFFOLK AVE
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City | BRENTWOOD
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State | NY
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Zip | 11717-4498
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Country | US
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Telephone | 631-947-0030
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F305163
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License Number State | NY
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