Provider Demographics
NPI:1427285527
Name:NEPHROLOGY&HYPERTENSION CONSULTANTS OF LONG ISLAND&QUEENS
Entity type:Organization
Organization Name:NEPHROLOGY&HYPERTENSION CONSULTANTS OF LONG ISLAND&QUEENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LIONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DESROCHES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-285-2850
Mailing Address - Street 1:1975 LINDEN BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4004
Mailing Address - Country:US
Mailing Address - Phone:516-285-2850
Mailing Address - Fax:
Practice Address - Street 1:1975 LINDEN BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4004
Practice Address - Country:US
Practice Address - Phone:516-285-2850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH & DESROCHES MD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335744-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty