1245358340 NPI number — JOSEPH & DESROCHES MD PC

Table of content: (NPI 1245358340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245358340 NPI number — JOSEPH & DESROCHES MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH & DESROCHES MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEPHROLOGY & HYPERTENSION CONSULTANTS OF LONG ISLAND & QUEENS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245358340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 516
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY STREAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11582-0516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-285-2850
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1975 LINDEN BLVD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
ELMONT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11003-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-285-2850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOSEPH
Authorized Official First Name:
ANTONIO
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
516-285-2850

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  176371 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: 172523 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 172523P . This is a "HEALTHCARE PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01305357 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: AS699 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 176371P . This is a "HEALTHCAREPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2501072 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 176371S . This is a "HEALTHCARE PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01305348 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 172523 . This is a "LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 172523S . This is a "HEALTHCARE PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 176371 . This is a "LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 97F153 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P1069572 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00G361 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 164450 . This is a "ELDERPLAN" identifier . This identifiers is of the category "OTHER".




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