Provider Demographics
NPI:1972360006
Name:BLACKSTONE NP IN PSYCHIATRY PLLC
Entity type:Organization
Organization Name:BLACKSTONE NP IN PSYCHIATRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESROSIERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-509-3742
Mailing Address - Street 1:405 RXR PLZ
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-3811
Mailing Address - Country:US
Mailing Address - Phone:516-509-3742
Mailing Address - Fax:
Practice Address - Street 1:405 RXR PLAZA
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11556-3811
Practice Address - Country:US
Practice Address - Phone:516-509-3742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty