Provider Demographics
NPI:1003928987
Name:DESROCHES, LIONEL EMANUEL (MD)
Entity Type:Individual
Prefix:
First Name:LIONEL
Middle Name:EMANUEL
Last Name:DESROCHES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:11003-4025
Mailing Address - Country:US
Mailing Address - Phone:516-285-2850
Mailing Address - Fax:516-285-0038
Practice Address - Street 1:22414 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2023
Practice Address - Country:US
Practice Address - Phone:718-949-6433
Practice Address - Fax:718-949-0331
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172523207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE99928Medicare UPIN
NY97F151Medicare ID - Type UnspecifiedMEDICARE NUMBER