Provider Demographics
NPI:1194219865
Name:DUROSIER LOUIS, MINIOLLA (MD)
Entity Type:Individual
Prefix:
First Name:MINIOLLA
Middle Name:
Last Name:DUROSIER LOUIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1096
Mailing Address - Country:US
Mailing Address - Phone:914-365-3000
Mailing Address - Fax:845-205-7305
Practice Address - Street 1:701 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-1096
Practice Address - Country:US
Practice Address - Phone:914-365-3000
Practice Address - Fax:845-205-7305
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY321083207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program