Provider Demographics
NPI:1851482400
Name:DESIR, NYRLINE (FNP)
Entity type:Individual
Prefix:
First Name:NYRLINE
Middle Name:
Last Name:DESIR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WATER STREET 2ND FLOOR CRED DEPT
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:1055 STEWART AVENUE
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-3596
Practice Address - Country:US
Practice Address - Phone:516-938-0100
Practice Address - Fax:516-938-0120
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002738A363LF0000X
NYF343594363LF0000X
TN2005002258363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200947950Medicaid
INP01170018OtherRR MEDICARE PTAN
TN34460326Medicaid
TN34460326Medicaid
INP01170018OtherRR MEDICARE PTAN