Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | N005664-1 | NY |
N | 213EP1101X | Primary Podiatric Medicine | MD002675 | NJ |
N | 213EP1101X | Primary Podiatric Medicine | SC005652 | PA |
NPI | 1093709610 |
---|---|
Provider Name | Sergine Desrosiers |
First Address | Brooklyn, NY 11203-2017 |
Second Address | Brooklyn, NY 11216-2522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 25/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1964230004 | (05) | PA |
8696900 | (05) | NJ |
U87732 | (02) | NY |