Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 172523 | NY |
N | 111NI0900X | Internist | 172523 | NY |
Y | 207RN0300X | Nephrologist | 172523 | NY |
NPI | 1003928987 |
---|---|
Provider Name | Lionel Emanuel Desroches |
First Address | Elmont, NY 11003-4025 |
Second Address | Laurelton, NY 11413-2023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 10/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E99928 | (02) | NY |