MEDICARE: INGRID DESROCHES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	292522	NY
2	208000000X	Pediatrics Physician	79738	CT

General Provider Information

NPI Number	:	1235516360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRID DESROCHES

Provider Business Mailing Address
First Line	:	500 COMMACK RD UNIT 150F
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-5009
Country	:	US
Telephone Number	:	631-499-4114
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 COMMACK RD UNIT 150F
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-5009
Country	:	US
Telephone Number	:	631-499-4114
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2015
Last Update Date	:	12/02/2025

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Directions to “ INGRID DESROCHES ” Practice Location

Language	Start Address	Practice Location

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